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Abstract #45565 Published in IGR 13-2
Estimating the extent of non-adherence in patients with glaucoma and its association with satisfaction with information recorded
Cate H; Bhattacharya D; Clark A; Fordham R; Holland R; Broadway DCInternational Journal of Pharmacy Practice 2011; 19: 8-9
Background: Glaucoma is a chronic condition, the adverse progression of which can be prevented with appropriate therapy, in the majority of cases. Therefore, medication non-adherence has been associated with progressive visual field loss, blindness([1]) and unnecessary additional prescribing or surgery. Clinicians advocate greater medicines information provision to patients([2]) and satisfaction with medicines information has been associated with improved adherence.([3]) Adherence is, however, multifactorial and thus greater evidence regarding the relationship between adherence and information receipt is necessary.([4]) Rigorous evidence for novel adherence interventions requires a valid and reliable measure, but a gold standard for measuring adherence to glaucoma therapy has yet to be established.([5]) An electronic medication monitoring system may be effective but may itself influence medication taking behaviour. This study aimed to determine whether patients with glaucoma desire additional medication-related information and should such a need exist, to describe where those needs lie. A secondary aim was to estimate the effects on patient medication-taking behaviour of monitoring with the electronic Travalert Dosing Aid (TDA). Method: Full ethical and research governance approval was obtained. One hundred patients attending an out-patient glaucoma clinic were approached and stratified by phase of travoprost use: newly prescribed or follow-up. At baseline, self reported adherence to travoprost was obtained from follow up participants using Morisky([6]) with a score of 0 categorised as adherent and 1 to 4 as non-adherent. All participants were given a TDA and daily adherence data were collected after 2 months of monitoring. Morisky([6]) self-reported adherence was then obtained from both newly prescribed and follow up participants. Satisfaction with received information (SIMS)([7]) about travoprost was assessed using an abbreviated 14-item version (adapted by the authors), with a SIMS score of 14 indicating complete satisfaction. Results: Consent was obtained from 98 (48 new, 48 follow-up) patients of which 50 (51%) were male with a median (IQ) age of 71.8 (63, 77.5). The median (IQ) duration of therapy with travo-prost was 118 (52.8, 535.0) days. Eighty-two participants completed the SIMS questionnaire; median SIMS score (IQ) 10 (6, 12). Participants were particularly dissatisfied with information received about 'how long it will take to act' which was reported by 49 (57 (plus or minus) 10.4%) and 'how to tell whether the medication is working' which was reported by 54 (63.5 (plus or minus) 10.6%). There was no significant relationship (Spearman's correlation coefficient) between the number of days that a patient had reported receiving travoprost therapy and satisfaction with information received (r = -0.002, p = 0.985,). Morisky data pre and post TDA were available for 37 follow up participants; 12 (32.4%) were non-adherent initially and 7 (18.9%) at 2 months (p = 0.125, McNemar Test). Discussion: The SIMS scores demonstrated that patients desired further information that had not been acquired over time - this may be due to altered expectations or the initial need not being addressed. The elements with greatest dissatisfaction might have been a reflection of the asymptomatic or chronic nature of glaucoma. Accepting the limitations of a before and after design, we found no evidence that TDA altered adherence behaviour and thus the use of an electronic adherence monitoring device may be feasible; a larger, appropriately powered trial is necessary to confirm these findings.
H. Cate. Norfolk and Norwich University, Hospital NHS Foundation Trust, Norwich, United Kingdom.
Classification:
11.17 Cooperation with medical therapy e.g. persistency, compliance, adherence (Part of: 11 Medical treatment)
