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Editors Selection IGR 16-4
Medical Treatment: Patient adherence behaviours
Comment by Michael Boland on:
53033 Patterns of adherence behaviour for patients with glaucoma, Cate H; Bhattacharya D; Clark A et al., Eye, 2013; 27: 545-553
The role of patient adherence with topical glaucoma medications is increasingly recognized as a problem in that multiple studies have shown that a significant minority of patients do not use them as prescribed. Prior work has shown that electronic monitors like the Travatan Dosing Aid (TDA) are accurate in recording patient use of glaucoma medications. Furthermore, work by Ajit et al. has suggested patterns of non-adherence that include outright cessation of dosing, drug holidays, and frequent missed doses. Cate et al. therefore set out to assess adherence in a UK-based population using the TDA. They then analyzed the patterns of non-adherence and assessed the ability of the Morisky Medication Adherence Scale (MMAS) to identify those subjects who were determined to be non-adherent using the electronic monitor. As with other recent studies using electronic monitors, they found a minority (41%) using their drops incorrectly. Also consistent with prior work, they found that patient-reported adherence was not correlated with that measured electronically. As a more formalized method of self-report, the MMAS was shown to be reasonably sensitive for finding non-adherent patients but was only poorly specific (17%), suggesting it produces too many false positive results to be useful in a general population. Unlike some prior studies on adherence, the authors found no demographic factors that were statistically significant predictors of adherence.
The glaucoma community is still in need of an accurate method of identifying patients most likely to be non-adherent and then of one or more interventions to improve their adherence
This study provides important insight into medication adherence in a UK-based patient population. At the same time, these findings differ from prior work in meaningful ways. For example, the authors suggest that their finding of no relationship between demographic factors and adherence is consistent with prior work whereas the cited studies either do not assess these relationships or do in fact find demographic factors that are related to non-adherence (age, race, health status). The authors also claim that interventions to improve adherence have not been evaluated whereas at least three different groups have reported randomized studies of such interventions (Okeke 2009, Gray 2011, Glanz 2012).
At this point, the glaucoma community is still in need of an accurate method of identifying patients most likely to be non-adherent and then of one or more interventions to improve their adherence.
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