April 2014
Volume 55, Issue 13
Free
ARVO Annual Meeting Abstract  |   April 2014
Evaluation of two metrics for identifying poor glaucoma medication adherence compared to objective adherence measurements
Author Affiliations & Notes
  • Jaya Badhwar
    Department of Ophthalmology, Duke University, Durham, NC
    Health Services Research and Development, Durham VA Medical Center, Durham, NC
  • Hayden Bosworth
    Department of Medicine, Duke University, Durham, NC
    Health Services Research and Development, Durham VA Medical Center, Durham, NC
  • Betsy Sleath
    School of Pharmacy, University of North Carolina, Chapel Hill, NC
  • Susanne Danus
    Health Services Research and Development, Durham VA Medical Center, Durham, NC
  • Logan Christensen
    Department of Ophthalmology, Duke University, Durham, NC
  • Kelly W Muir
    Department of Ophthalmology, Duke University, Durham, NC
    Health Services Research and Development, Durham VA Medical Center, Durham, NC
  • Footnotes
    Commercial Relationships Jaya Badhwar, None; Hayden Bosworth, None; Betsy Sleath, None; Susanne Danus, None; Logan Christensen, None; Kelly Muir, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science April 2014, Vol.55, 5549. doi:
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      Jaya Badhwar, Hayden Bosworth, Betsy Sleath, Susanne Danus, Logan Christensen, Kelly W Muir; Evaluation of two metrics for identifying poor glaucoma medication adherence compared to objective adherence measurements. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5549.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: Poor adherence to the prescribed glaucoma medication regimen may lead to preventable blindness. Previous work suggests that providers may not accurately identify nonadherent patients. The purpose of this project was to compare 2 screening methods for identifying nonadherence on the criteria of feasibility and correlation with objective adherence measurements from an electronic monitor.

Methods: Patients from 2 eye clinics (a university practice and a VA hospital) with medically-treated glaucoma were given a survey of medication adherence including the question “how many times did you miss your drops in the last week” and a visual analog scale (VAS) on which patients mark on a line how much of the time they take their drops as prescribed. Participants received electronic monitors to record when the medication was accessed until the next clinic visit. The 2 measures were evaluated for feasibility (how many participants responded), sensitivity and specificity for detecting nonadherence.

Results: Adherence was defined as the proportion of prescribed doses taken according to the monitor. Of 142 participants, 132 returned the monitors, average duration of use 179 days (SD 69, median=179). Mean percent of the prescribed doses taken was 83.3 (SD 23, median 94). For the question, “how many times did you miss your drops last week?”, 23 failed to answer; 100 responded that they had not missed any drops in the last week. 2 failed to complete VAS, 124 responding with <100% adherence. In regards to detecting adherence of <80%, a VAS score <1 was 90% sensitive and 13% specific. A response of >1 on the item “how many times did you miss your drops in the past week” was 26% sensitive and 88% specific for detecting nonadherence.

Conclusions: More participants responded to the VAS than to the question regarding missed drops. Possible explanations include that the VAS is easier to interpret or is associated with less perceived stigma than admitting to a specific number of missed doses. The VAS was more sensitive at detecting poor adherence than the question regarding missed drops, but less specific. The low specificity of the VAS suggests that although the tool may be a useful screener for nonadherence, clinicians must delve more deeply if the screen is positive to determine the nature of the patient’s difficulty with the prescribed regimen.

Keywords: 466 clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials  
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