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Editors Selection IGR 16-4

Medical Treatment: Adherence

Comment by David Friedman on:

25107 An exploratory study of factors influencing glaucoma treatment adherence, Stryker JE; Beck AD; Primo SA et al., Journal of Glaucoma, 2010; 19: 66-72

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Stryker et al. (435) report on factors influencing adherence in 80 mostly African-American patients selected from either a Veterans Affairs hospital practice or a large public hospital in the southeast United States. All patients had been taking topical ocular hypotensive agents for at least a year. Patients treated in these locations have access to subsidized medications. Recruitment occurred in two ways and was associated with adherence to medications. Patients who were more likely to be 'adherent' were recruited via flyers posted in the eye clinics while less adherent patients were actively recruited after a chart review determined that they had missed at least one appointment. Whether or not the use of different recruitment methods introduced a bias into the findings is difficult to determine.

Participants were interviewed qualitatively by a trained research assistant either over the phone or in person for anywhere from 30 to 90 minutes. Open-ended questions were used and responses were coded into categories by two independent graders who adjudicated disagreements. Adherence was determined by self-report, review of pharmacy claims data, or visit attendance. For self-reported nonadherence the researchers required both an admission of missing at least one dose in the previous week and documentation of problems with adherence by the treating doctor in the chart. Refill non-adherence required both a one-month lag in pharmacy refill and an admission by the patient that he/she ran out of medications. Furthermore, missed visits led to a 'non-adherent' classification. Using these definitions, 60% were 'non-adherent'.

Non-adherent patients were less likely to feel the physician spent enough time with them

This study had a relatively small sample size, and therefore, failure to identify associations may have been due to limitation in power. Nevertheless, the authors identified important associations. Nonadherent patients were less likely to feel the physician spent enough time with them. Although not statistically significant, 23% of non-adherent patients reported difficulty administering the drops as opposed to 9% of the adherent group. As has been reported previously, non-adherent patients reported greater difficulty remembering to take their drops. Those with somebody to help with the drops were more likely to be adherent, as were those who recognized that they could loose vision from glaucoma. In summary, this paper studied a largely African-American population and used a somewhat unusual composite definition of adherence. The number studied was relatively small, which may have limited the ability to identify some associations. The authors' findings support previous work on the importance of patient-doctor interactions, patient belief systems about the risks posed by glaucoma, and the benefit of social support in adhering to therapy.

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