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Patients experience multiple barriers in glaucoma medication adherence
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Eye care professionals have to address each patient's adherence individually, researchers reported in a study recently published in Ophthalmology.
Newman-Casey and colleagues wrote that patients had a unique set of barriers in their adherence to glaucoma medication in their prospective, cross-sectional survey.
To assess barriers to medication adherence as well as the frequency of 11 common barriers, researchers created a survey for 190 glaucoma patients on at least one glaucoma medication. Participants completed the 33-question survey, which included four sections: demographic information, barriers to optimum adherence, self-reported adherence measured by the Morisky Adherence Scale and patients’ interest in an assist device.
Results showed that 61% of participants identified multiple barriers as obstacles to glaucoma medication adherence, and 29% of participants self-reported poor adherence. Researchers found that, of the 11 common barriers, forgetfulness, poor self-efficacy, difficulty with the medication schedule and difficulty with drop administration were associated with poor adherence.
"This study showed that each patient is likely to have his or her own unique set of issues that will need to be addressed to optimize adherence," the authors concluded. "Furthermore, the greater the number of barriers identified, the greater the likelihood of nonadherence. Interventions focused on improving adherence will need to ensure that they build self-efficacy, teach patients proper eye drop instillation and address issues with forgetfulness and difficulties with the medication schedule. Interventions also will need to individualize, or tailor, information and approaches to address each patient’s unique set of barriers."
They continued: "Future research should evaluate whether tailored education and counseling can increase patients’ motivation to manage their glaucoma and improve their medication adherence."
Disclosures: Newman-Casey reported no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
Perspective
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Blair Lonsberry, OD, FAAO
Treatment nonadherence is a major issue in the management of glaucoma patients. In this study, Newman-Casey and colleagues report that most patients perceive some form of barrier to taking their eye drops consistently, and that these factors tend to be individualized.
Top barriers include forgetfulness, poor self-efficacy, difficulty with the medication schedule and difficulty with drop administration. All were associated with poor adherence, and greater number of perceived barriers was associated with worse nonadherence. Interestingly, medication cost was not considered a top barrier to adherence.
There are some limitations in generalizing these results to all glaucoma patients.
First, this study was conducted in two practices in the U.S.; it was not a multicenter clinical study with sites all over the U.S. Regional variations may exist.
Second, study participation was voluntary after being approached in the waiting room. It is possible that nonadherent patients declined participation in the study.
For me, the highlight of this article was the recommendation that patient education needs to be individualized to their specific perceived barriers to adherence, and that this education should be a part of every patient visit.
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