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Editors Selection IGR 9-4

Medical Treatment: Failure to adhere to drug taking regimens

Comment by David Friedman on:

23893 Barriers to adherence with glaucoma medications: a qualitative research study, Lacey J; Cate H; Broadway DC, Eye, 2009; 23: 924-932

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This qualitative research study from England by Lacey et al. (867) evaluated 24 patients (62% participation rate) with glaucoma of at least one year duration who were taking two or more medications. Fourteen subjects participated in two focus groups and the findings from these were used to guide 10 patient interviews (carried out by a psychologist at the patients' homes). The interviews covered patient history of glaucoma diagnosis, drop use, attitudes towards taking drops, memory, patient-physician dynamics, motivating factors, and education about glaucoma. Questions were open-ended and interviews lasted from 40 to 90 minutes.

Patients were mainly white, equally male and female, and mostly over 60 years of age. Various themes rose out of the focus groups and interviews. Most felt they had received too little education about glaucoma and that this was typically done using handouts. Physicians appeared too busy. Several complained about a lack of discussion on how to use the drops and expressed concern that it was difficult to administer the drops to the eye when first using them. While some doubted the efficacy of the drops, most appeared concerned about vision loss and this motivated them to take drops as directed. Those who doubted efficacy 'chose' not to take drops at times. Patients who frequently 'forgot' drops appeared less concerned about disease worsening than those who stated they rarely forgot. Altered daily routines (holidays, travel), affected drop taking.

While there are clear limitations (e.g., small sample, no presentation of the level of visual field damage, and no reporting on other comorbidities), this study highlights several themes that are common in research on adherence in glaucoma and other chronic diseases. In the non-judgmental environment created in these focus groups and interviews, many patients admitted to suboptimal adherence. The literature is consistent that a significant minority does not take medications as prescribed. Patients require more attention at the beginning and often do not feel adequately educated about the disease or about how to cope with taking medications. Greater emphasis is clearly needed here. Finally, the same barriers seem to come up using multiple methods; poor physician-patient communication, lack of instruction, a perception that not taking drops is safe, and difficulty taking drops when traveling or altering one's schedule, are all important causes of failure to adhere to drug-taking regimens.

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