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Psychosocial disorders may interfere with glaucoma medication compliance
Glaucoma patients with hypochondriasis and depression are less likely to adhere to an eye drop regimen.
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Patients with psychosocial disorders such as depression or hypochondriasis may not adhere to their prescribed glaucoma medication regimens despite various interventions, according to a study.
“Doctors need to be aware of the psychosocial makeup of the patient that they are seeing,” Michele C. Lim, MD, lead author of the study, said in an interview with Ocular Surgery News. “For some [glaucoma patients], it’s easy for them to adhere, but others may have psychosocial issues or plain fear, and they have trouble adhering to their eye drop regimen.”
In a prospective, controlled clinical trial, 38 patients were randomized to an intervention group and 42 to a nonintervention group, with all patients completing the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) at the beginning of the study so that personality types could be associated with patient adherence outcomes.
Patients in the intervention group received monthly automated telephone calls as reminders to take glaucoma medication and at 3 months returned to the physician’s office for an educational interactive session. Patients in the nonintervention group did not receive any reminder phone calls or educational sessions and returned for an office visit at 5 months.
Adherence rates, considered as the percent of dosages taken on schedule, did not improve significantly in either group. At 5 months, mean adherence rates were 76% for the intervention group and 81% for the nonintervention group.
“We were very surprised that the intervention group was not better [when] we threw so many things at them — the phone calls, the interactive series with one of our coordinators at their visit, the more frequent visits,” Lim said.
There are a few reasons why the interventions did not work. The telephone calls made to the patients may have been too passive and could have worked better if they were interactive, as seen in previous studies that required an input of personal information when the calls came in. Because more people seem to be electronic savvy and have access to mobile phones, using text messages or interactive text messaging may be a better way to improve medication adherence rates.
“A cell phone-based electronic reminder could potentially harness technology better for glaucoma patients,” Lim said.
When MMPI-2 characteristics were considered in all patients, depression (P = .01) and hypochondriasis (P < .0001) were significantly associated with worse adherence. Depressed patients may lack motivation and energy, they may be pessimistic, or they may be more forgetful, Lim said.
“Patients with hypochondriasis may be fearful of their disease or hypersensitive to medication side effects and interpret them as a worsening of the disease,” she said. “We do know that when people are experiencing side effects that they are less likely to take their drops.”
“Also, taking an eye drop for glaucoma is an everyday reminder that there is something wrong with you,” Lim said. “So if you are fearful of your disease, you may skip taking your eye drops as a denial mechanism.” – by Cheryl DiPietro