<p>Factors Affecting Compliance to Anti-Vascular Endothelial Growth Factor Treatment of Diabetic Macular Edema in a Cohort of Jordanian Patients</p>

Abstract

Purpose: To determine compliance rates and characteristics and to investigate factors affecting patients' adherence to treatment with anti-vascular endothelial growth factors (anti-VEGFs) for diabetic macular edema (DME) in a cohort of Jordanian patients. Methods: A retrospective case series wherein the files of DME patients treated with anti-VEGFs were reviewed and analyzed for factors affecting treatment compliance was undertaken. Demographic, clinical and ocular characteristics were recorded. All patients were also interviewed by phone using a structured questionnaire. Univariate and multivariate analyses were performed to determine factors associated with compliance. Results: A total of 117 patients (65 males 52 females) were included in this study with a mean age of 62.93 years (±9.75). Approximately, 85% of patients were compliant to their treatment and follow-up plan during the first year of management. Subjective perception of visual improvement after receiving three loading doses was the only independent variable with a unique statistically significant contribution to compliance. All other studied factors in this group of patients were not significantly associated with patient compliance. Conclusion: VEGF suppression via the intravitreal route to treat DME is a long-term process that requires caregiver dedication but also proper patient compliance. Addressing real-life barriers in those patients may help guide future strategies to improve the treatment experience, lower the financial burden and contribute to better outcomes. Patients' perceptions of possible treatment outcomes at the short term may influence their long-term commitment to therapy.

Adherence of patients with diabetic macular oedema to intravitreal injections: A systematic review

“…Further to this, some studies reported several clinical factors that were associated with adherence. 32,36 Clinical factors included the prospect of vision improvement, 35 subjective gains in visual acuity, 37 complications with injections, 36 unilaterality of the injections, 35 stage of nonproliferative diabetic retinopathy 34 and baseline visual acuity of less than 6/15. 34 This is in part consistent with the literature that suggests that poor visual acuity is often related to poor adherence 41 and to treatment discontinuation.…”

“…Although treatment regimes and the timing of follow-up review appointments varied between studies, almost all articles included patients who were naïve 31,32,35,36 to treatment and who were followed for a minimum of 1 year. 31,32,[34][35][36][37]…”

“…[32][33][34][35][36][37] Methods utilized to identify potential factors included either interviews undertaken via telephone or in the clinic 33,[35][36][37] and/or data extracted from medical records. 32,34,36,37 Interviews were either structured [35][36][37] or in-depth. 33 Factors found to be associated with non-adherence or adherence are reported in Table 2.…”

“…Four studies 32,34,35,37 utilized predetermined clinical and demographic risk factors to analyse against adherence, however in order to identify potential risk factors Habib et al 35 also validated a self-designed structured questionnaire based on the health belief model for use in their study. Factors that were not associated with adherence included demographic factors such as age (P = .712) 35 (P = .757) 32 (P = .94), 34,37 sex (P = .689) 35 (P = .63) 32 (P = .458), 37 level of education (P = .251) 35 (P = .752), 37 insurance coverage (private vs government) (P = .13) 34 (P = .408), 37 employment status (P = .501), 37 mode of transportation (P = .986), 37 distance from home to the clinic 34 and DMO awareness (P = .269) and clinical factors such as eye involvement (bilateral vs unilateral involvement) (P = .17), 34 disease laterality (P = .243), 37 bilaterality of the injection (P = .185), 32 incidence of treatment complications (P = .688) or type of treatment complications (P = .361), 37 duration of symptoms prior to diagnosis (P = .679), 37 visual acuity gains (P = .407), 37 impaired mobility (P = .720) 32 (P = .921) 37 and presence of comorbidities including hypertension, ischemic heart disease and kidney disease (P = .847-.537). 37 Factors associated with non-adherence included stage of non-proliferative diabetic retinopathy (P = .04), 34 race, 34 average adjusted gross income, 34 absence of health care funding (P = .002), 35 unilaterality of the injection (P < .001), 35 higher perceived barriers (P = .011), 35 lower perceived benefits (P = .015), 3...…”

“…32,34 Although Gao et al 34 reported that patients with baseline vision of 6/15 to 6/24 were 1.69 times more likely to be lost to follow-up and that those with vision worse than 6/24 were 3.57 times as likely to be lost to follow-up compared with those with vision better than 6/15, Ehlken et al 32 reported that there was no association between baseline vision of >0.1 to 0.3 logMAR (>6/7.5-6/12) (P = .617) or <0.3 logMAR (<6/ 12) (P = .352) of the study eye 32 and risk of nonadherence and Abu-Yaghi et al reported no association between adherence and baseline visual acuity. 37 Two 33,36 of the six papers documented specific patient reasons for non-adherence Weiss et al 36 found that the most common reasons for non-adherence were presence of other illnesses (20%) followed by no explanation (17%) and personal reasons (12%). Other reasons provided by patients included clinic problems (10%), change of doctor (8%), problems with the insurance company (8%), problem of communication (7%), no prospect of improvement (6%), complication with injection (3%) transportation issues (3%) and family problems (2%).…”