Patients, providers prioritize sociobehavioral factors in glaucoma treatment adherence
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Patients and providers agree that sociobehavioral factors are a key determinant of glaucoma treatment adherence, but they disagree in other areas, according to a study published in Optometry and Vision Science.
“Sociobehavioral factors such as poor patient-provider relationship, low self-efficacy and psychological stress have been found to affect adherence in glaucoma,” Shervonne Poleon, BS, of the department of optometry and vision science at the University of Alabama at Birmingham School of Optometry, and colleagues wrote. “We aimed to elicit consensus between patients and providers around key determinants of adherence using Delphi surveys. We used a mixed-methods approach to assess treatment perspectives and hypothesized that patients would place a greater emphasis on sociobehavioral factors compared with providers.”
Researchers evaluated treatment beliefs, barriers, facilitators, motivators and needs in 18 patients with glaucoma and providers. The first round of the survey evaluated agreement with 46 statements on a 5-point Likert scale. In the second round, statements with 80% or more agreement were prioritized by the panelists on degree of importance to treatment.
Among the 46 statements, there was consensus between patients and providers on the influence of perceived treatment efficacy, good provider relationship, good quality of life, psychological stress, glaucoma knowledge, instillation skill and forgetfulness regarding glaucoma adherence, according to the study. The statements that failed to reach consensus dealt with regimen complexity, instillation skill and low motivation.
“To our knowledge, this is the first study to comparatively assess treatment perspectives among patients with glaucoma and providers using both qualitative and quantitative methods. Our hypothesis was partially supported, as both groups prioritized sociobehavioral factors as key treatment beliefs, barriers, motivators, facilitators and needs,” Poleon and colleagues wrote.
“However, per Delphi studies, the external validity of our findings lies in whether they are substantiated in real-world situations,” they added. “Continued juxtaposition of patient and provider perspectives could spotlight other underexplored areas and inform the development of successful interventions for improving treatment adherence in glaucoma.”
Perspective
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“Drugs don’t work in patients who don’t use them.”
These words, attributed to former U.S. Surgeon General C. Everett Coop, crystalize one of the biggest challenges in managing glaucoma. Adherence to treatment of a chronic condition, particularly one that is initially asymptomatic, is notoriously poor and a strong contributor to disease progression.
As practitioners, we believe that we understand the factors that contribute to poor adherence, like preservative intolerance, inconvenient dosing schedules or lack of trust between patient and provider.
However, what I found most interesting about this study were sociobehavioral factors identified by patients that were not recognized by practitioners, including the need for support from loved ones, having someone to talk to about their glaucoma, the burden of caring for others and access to new information about their disease. Conversely, several barriers identified by doctors, including treatment complexity and cost, were not acknowledged by patients.
It appears that optometrists and ophthalmologists do not understand the nuances of this challenge nearly as well as we think we do. Because poor adherence to treatment is a modifiable risk factor for disease progression, it behooves us to do better.
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