Abstract
Abstract: :
Purpose: Glaucoma is a leading cause of blindness in Brazil and worldwide. It is estimated that over 500,000 Brazilians have glaucoma, being at risk for adherence problems with the therapeutic regimen. This study aims to evaluate the prevalence of non–adherence with topical drug regimens in glaucoma patients and to investigate related variables and risk factors. Methods: A cross–sectional study involving 199 consented patients under topical anti–glaucomatous treatment, interviewed with a structured questionnaire. Patients who reported taking 100% of the prescribed eydrops in the last three days were considered adherent. The chi square test was first used to compare the prevalence of non–adherence among two or more categories of variables. A multivariate model was then performed. The variables associated with non–adherence in the univariate analysis were fitted in a logistic regression model using a backward strategy. Results: The non–adherence prevalence was 32,2% (CI95% 25,7% – 38,7%). The univariate analysis showed statistically significant association between non–adherence and number of prescribed doses (p<0,001), pilocarpine prescription (p<0,001), glaucoma hemifield test (p=0,028), self reported "absolute" adherence (p<0,001) and automatic attitude to taking eyedrops (p<0,001). The variables that remained in the multivariate analysis were number of prescribed doses, self reported "absolute" adherence and automatic attitude to taking eyedrops. The adjusted odds ratios for non–adherence were 1,27 (CI95% 1,12 – 1,47) for one daily dosage increase (p=0,001), 20,09 (CI95% 5,22 – 77,32) for not having an automatic attitude to taking eyedrops (p<0,0001), and 5,69 (CI95% 2,53 – 12,80) for not reporting "absolute" adherence (p<0,0001). Conclusions: This is the first study in Brazil that evaluates systematically the non–adherence to glaucoma treatment and it’s related characteristics, establishing identifiable risk factors. The non–adherence prevalence found is similar to the rates obtained in other countries, but higher adherence rates are probably needed for glaucoma’s appropriate management. This study points out risk factors associated to non–adherence, and suggests that less complex regimens, as well as strategies that focus on the patient relationship with the treatment as an everyday life routine, are clinical techniques that could increase adherence.
Keywords: clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials • clinical (human) or epidemiologic studies: risk factor assessment • intraocular pressure