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E. L. Lamoureux, O. Leung, J. C. Crowston, G. Rees; Factors Associated With Non-Adherence to Ocular Hypotensive Treatment in Patients With Glaucoma. Invest. Ophthalmol. Vis. Sci. 2009;50(13):2449.
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To determine the socio-demographic factors and beliefs associated with non-adherence in patients on glaucoma medication for at least a year. A secondary aim was to compare adherence using medication diaries and electronic monitoring.
Participants were recruited from glaucoma clinics at a tertiary ophthalmic hospital and their socio economic and clinical data were collected. Each participant also completed the following scales: Reported Adherence to Medication; Brief Illness Perception; and Beliefs about Medicines. In a subsample (n=20), medication diaries was used to self-report every episode of eye-drop administration over one month. The Travalert Dosing Aid (TDA, Alcon, Fort Worth, Texas), an electronic monitor device, was used to validate the dairies.
131 participants were recruited (mean±SD age 67.7±13.5 yr; and 61.1% male). Most had early stage glaucoma (52.7%) and POAG (27.5%). The mean±SD IOP for the right eye and the duration of eye-drop utilisation were 20.4±16.3 and 9.84± 8.96 yr, respectively. Overall, 45 (34%) participants reported some degree of non-adherence. Of the non-adherers, most (n=32, 71%) reported unintentional non-adherence (e.g., forgetting), although a proportion reported intentional non-adherence (n=13, 29%). Compared to those who reported full compliance, non-adherers were significantly younger, less likely to have other health conditions or to be using medicines other than their eye drops, more recently diagnosed with glaucoma and reported more recent use of eye drops for glaucoma (p<0.05). Adherers held a stronger belief in the necessity for eye drops compared to non-adherers (p<0.05). The mean adherence rates were 81.2 % and 97% (p<0.001) for the TDA and medication diaries, respectively, suggesting substantial inaccuracy using the self-report diary method.
Patient education programs aimed at improving patients understanding of the rationale for glaucoma eye drops are needed to improve adherence. Interventions should target younger patients, those recently diagnosed and new to medication regimes.
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