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Natasha V. Nayak, Jun Lin, Susan Forster, James C. Tsai; Assessment of Barriers to Medication Adherence and Follow-up Exams in Glaucoma Patients. Invest. Ophthalmol. Vis. Sci. 2012;53(14):4485.
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Past studies suggest that up to 60% of glaucoma patients are non-adherent with their medications and up to 37% are lost to follow up. Further assessment of multiple psychosocial risk factors is necessary to understand patient factors contributing to medication and follow-up non-adherence. The purpose of our study was to understand the role of psychosocial factors in adherence to glaucoma management.
This was a cross-sectional survey with concomitant retrospective chart review. Ninety-five (95) treated glaucoma patients were surveyed (with previously validated measures) regarding medication adherence, glaucoma symptoms, quality of life, medical mistrust, trust in physicians, and social support. Patient charts and appointment records were reviewed for current and past ocular history and appointment adherence.
32 (34%) patients admitted to non-adherence to medications within the past 2 weeks. Barriers to medication adherence were associated with living alone (p=0.01), increased number of glaucoma medications (p<0.01), increased drop administration frequency (p<0.01), concomitant diabetes (p<0.01), intermediate income levels (p=0.02), and medical mistrust (p=0.04). Patients who had missed appointments (27%) had fewer years of follow-up (p=0.001) and glaucoma diagnosis for less than 5 years (p=0.004). Patients with frequent cancellations had more satisfaction with their visual function (p=0.02), less ocular pain (p=0.02), some component of private insurance coverage (p=0.01), and glaucoma duration for less than 2 years (p=0.01). There was no association between non-adherence to medication and non-adherence to follow-up appointments or frequent cancellations.
Our study documents high non-adherence rates to glaucoma medications within a short recall period. Psychosocial factors constitute significant barriers in adherence to glaucoma management. In addition to medication regimen, factors such as comorbidities, income level, insurance, medical mistrust, living alone, and duration of glaucoma should be considered when aiming to improve glaucoma management adherence.
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