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Editors Selection IGR 15-1
Medical Treatment: Adherence to once-daily treatment
Comment by David Broadway & Heidi Cate on:
52368 Development and Validation of a Predictive Model for Nonadherence with Once-Daily Glaucoma Medications, Chang DS; Friedman DS; Frazier T et al., Ophthalmology, 2013; 120: 1396-1402
The authors have developed a model to aid the prediction of poor adherence to medication and thus guide where to focus interventions to improve adherence ‐ an admirable concept. A 6-variable predictive model was drawn from non-adherence data from the Travatan Dosing Aid study cohort (n = 196). The model was validated against an independent population using data from the Automated Dosing Reminder Study cohort (n = 407).
Factors associated with poor adherence were young age, black race, poor general health, short duration of therapy, low self-report of adherence and admission of failure to follow physician advice. Presence/absence of the factors enabled calculated 'probabilities' of non-adherence. However, it is important to remember that patients who are negative for the six identified factors are not certain to be adherent.
Patients who had a shorter duration of glaucoma treatment were less likely to be adherent, and it was suggested that this might be attributable to better glaucoma knowledge and better awareness of drop administration. The other predictors identified were not sociodemographic/ medical related factors and required additional questioning to ascertain self-reported adherence, perceived poor health status and likelihood of following doctor advice. In our opinion, these predictors are closely linked with patient attitudes and health beliefs that are likely to change with time. Ideally prediction of non-adherence should be repeated over individual patient lifetime periods of follow-up.
In clinical practice, all patients should be considered potentially non-adherent and all continually motivated to adhere to their therapy
Whilst the study populations were relevant to US clinical practice, the study was limited to patients using a once-daily prostaglandin and to two specific US populations. The model showed good calibration and generalizability between the two sample populations, but the relationship between adherence and sociodemographic factors, intelligence/ education and different healthcare systems remains complex and thus generalizability of these results to other patient populations may be inappropriate.
In clinical practice, all patients should be considered potentially nonadherent and all continually motivated to adhere to their therapy.
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