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M.J. Atkinson, A. Pleil; Physician and Patient Qualitative Perspectives on Eyedrop Administration . Invest. Ophthalmol. Vis. Sci. 2006;47(13):3454.
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To describe physicians’ and patients’ perceptions of barriers to the proper and effective administration of ocular medications.
Face–to–face, in–depth, one–hour interviews were conducted with 70 patients and 70 physicians across four countries (US, UK, France and Japan). Physicians were required to be practicing ophthalmologists who see at least 10 ocular hypertensive or glaucoma patients per month and have a history of prescriptive treatment using one or more ocular antihypertensive medications. Patients were characterized by length on therapy, stage of disease, comorbidities, and treatment regimen. A semi–structured interview schedule was used to explore their perceptions about barriers to medication use.
Physicians reported that administration difficulties affected higher proportions of new users, elderly and patients with dexterity problems. One–third of patients interviewed reported ongoing problems in self–administration and 20% percent reported requiring assistance due to a physical limitation. Even experienced users reported facing some physical challenges in accurate self–administration. Patients recommended solutions to these problems that focus on easily and accurately ensuring only a single dose is delivered successfully to the eye; and more specifically that upright administration (no backward head tilt), an easier–to–squeeze bottle, and easier aiming are areas for improvement in bottle technology. Both physicians and patients noted "not remembering" as one reason for occasionally missing a dose. Patients described simple ways they overcame this particular problem such as incorporating dosing in their daily routine, placing the bottle in a conspicuous place, or using written reminders. While the overall mentions of specific problems by patients and physicians showed consistency, physicians focused on cognition and patients on physical barriers. Across countries, problems mentioned were similar though the frequency of mentions varied.
There is a general agreement that many patients face daily challenges in self–administration of eye drops. The interview results suggest that physicians tend to emphasize cognitive barriers whereas patients report their major problems are physical in nature. Physicians are encouraged to ask not only when, but how patients are administering their medications in order to provide strategies and devices that may enhance their ability to comply with dosing instructions when necessary. Due to patients' concerns with physical barriers to administration, they expressed a particular interest in new delivery devices.
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