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Morgan L Pansegrau, Matthew Petroll, Inci Dersu; Analysis of Factors Affecting Nonadherence in Glaucoma Medication Utilization. Invest. Ophthalmol. Vis. Sci. 2014;55(13):538.
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Long term glaucoma medication utilization can be challenging for both the patient and physician. Identifying which factors increase the risk for nonadherence, could help determine which patients require closer follow up and intervention. Measuring real world adherence with medication utilization has previously proven to be problematic, but can be overcome by obtaining each patients refill rates, found in individual pharmacy databases.
This was an IRB- approved study involving a cohort of glaucoma patients who presented to the Jones Eye Institute from April 2011 to October 2012. To be considered for the study, one must have been medically treated for glaucoma greater than 6 months, and not have received any glaucoma medication samples during that time. 60 participants filled out a glaucoma medication utilization survey, and gave written permission to collect medication refill data for the previous 6 months from their pharmacy. All pharmacies were contacted for release of information, and pharmacy data was collected for 38 participants.
The compiled data from the survey and chart review were compared with pharmacy refill rates. The 38 participants ranged in age from 44 to 80 years old, had a gender distribution of 20 females and 18 males, and 32 had prescription drug coverage. There was no correlation between self reported refill rates in the glaucoma survey, and rates obtained from the pharmacies. Refill rates were inversely related to the number of listed medical conditions (R -0.34, P=0.036), a trend towards an inverse relationship with total systemic medications (R -0.28, P=0.087), and a trend towards gender disparity, with a higher percentage of men refilling medications (P=0.066).
Lower refill rates in subjects with increased medical conditions and total systemic medications likely reflect the impact of co-morbid conditions on glaucoma medicine utilization. Identification of such patients would be key to implement greater adherence measures. Socio-medical reasons may account for lower refill rates in women, but exact factors have not been elucidated. Self-reported adherence did not correlate with refill rates in this study; highlighting the requirement of objective measures to identify those at risk. This study indicates the need for a larger population study to further evaluate the influences of systemic disease burden and gender in glaucoma medication utilization.
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