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Abstract #67330 Published in IGR 17-4
The Maccabi Glaucoma Study: Treatment Patterns and Persistence With Glaucoma Therapy in a Large Israeli Health Maintenance Organization
Goldshtein I; Shalev V; Zigman N; Chodick G; Levkovitch-Verbin HJournal of Glaucoma 2016; 25: e386-e391
PURPOSE: To describe treatment patterns, adherence, and persistence with initial therapy among glaucoma patients in the community. MATERIALS AND METHODS: A population-based historical prospective cohort study, using the electronic medical databases of Maccabi Healthcare Services, a 2 million member health maintenance organization in Israel. Newly diagnosed glaucoma patients between 2003 and 2010, who purchased at least 1 antiglaucoma medication, were followed up to December 31, 2012. Outcome measures included medication adherence analyzed by proportion of days covered by drugs during follow-up time, and persistence with initial therapy measured by time until switch or discontinuation of first-line therapy. RESULTS: A total of 5934 incident definite glaucoma patients were identified, 13% of whom were nonadherent with therapy (covered <20% of the follow-up time), and only 25% exhibited high adherence (covered at least 80% of the follow-up period). Adherence was positively associated with female sex, age, socioeconomic status, frequent follow-up visits, and higher baseline intraocular pressure. Lower median adherence (P<0.01) was observed among patients of normal tension glaucoma (52%) and angle closure (59%) as compared with open angle (65%) and exfoliation glaucoma (68%). Patients treated by glaucoma specialists had similar adherence to those treated by general ophthalmologists (proportion of days covered=65% vs. 63%, P=0.42). Persistence with initial line of therapy varied by type of medication, with prostaglandin initiators exhibiting the highest persistence (13% reduced likelihood of switch or discontinuation as compared with β-blockers, P<0.01) and α-agonists the lowest persistence (39% increased likelihood of switch or discontinuation as compared with β-blockers, P<0.01). CONCLUSIONS: This large-scale analysis of real-world use of glaucoma medications reveals that adherence to glaucoma therapy is associated with medication type, patient's sex, age, socioeconomic status, type of glaucoma, follow-up visits, and baseline intraocular pressure.
*Medical Division, Maccabi Healthcare Services †Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv ‡Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel.
Full articleClassification:
11.17 Cooperation with medical therapy e.g. persistency, compliance, adherence (Part of: 11 Medical treatment)