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S. Vandenbroeck, F. Dobbels, I. Stalmans, S. De Geest, T. G. Zeyen; Non-Compliance, the Blind Spot in Glaucoma Treatment: Results From the Belgian Compliance Study in Ophthalmology. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4335.
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© ARVO (1962-2015); The Authors (2016-present)
Favorable outcomes of glaucoma are largely dependent on the patient’s ability to comply with prescribed eye drop treatment. Yet, compliance studies are usually single-center studies, including a small number of patients. The goal of the multi-center Belgian Compliance Study in Ophthalmology (BSCO) was to substantiate the magnitude of non-compliance (NC) with eye drop treatment in a large sample of glaucoma patients and to determine a possible association between NC and selected demographic & treatment characteristics.
A cross-sectional survey was performed in 876 glaucoma patients treated in 60 different ophthalmologic centers in Belgium. NC with eye drop treatment was assessed anonymously using a written self-report questionnaire developed for the purpose of this study. More specifically, patients were asked how many times they had forgotten to administer eye drops during the past 2 weeks. Patients had 4 answer options: never, seldom, once a week or daily. Two definitions of NC were explored: (1) missing one or more doses; (2) missing two or more doses in the past 2 weeks.
731 out of 876 (83.5%) questionnaires were available for data analyses. 39.7% and 12.3% of the patients admitted not being compliant to their treatment regimen in the last 2 weeks for resp. chosen definitions. Correlates of NC were robust as similar correlates were found for the 2 definitions. Significantly more male patients ((1) Χ2=10.46; p=0.001; (2) Χ2=9.15; p=0.002) and younger patients ((1) Mann-Whitney U= 54296; p<0.001; (2) Mann-Whitney U= 25669; p=0.073) were NC. Moreover, a higher number of daily doses was also positively associated with NC ((1) Mann-Whitney U=56580; p=0.013; (2) Mann-Whitney-U=22386; p<0.001). Within the group of NC patients, the evening doses were mentioned to be most frequently missed in 59.6% (1) and 56.7% (2) of the patients respectively. 47% (1) and 31.1% (2) suggested fewer doses per day as a valuable compliance enhancing intervention.
A substantial proportion of patients had problems with complying with eye drop treatment similar to previous evidence in smaller samples. Correlates of NC, male gender, younger patients and fewer doses, seemed quite robust. Clinicians should regularly screen for NC during routine follow-up. Patients at risk should be referred for compliance enhancing interventions. A possible pathway to improve compliance may be the reduction of daily doses.
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