Doctor–Patient Communication, Health-Related Beliefs, and Adherence in Glaucoma: Results from the Glaucoma Adherence and Persistency Study
Received 30 May 2007; received in revised form 1 November 2007; accepted 15 November 2007. published online 05 March 2008.
Objective
To use multiple data sources to determine drivers of patient adherence to topical ocular hypotensive therapy.
Design
Retrospective database and chart reviews in combination with prospective patient surveys. Diverse medical environments where insured patients in the research database seek care.
Participants
Three hundred patients with a new claim diagnosis for open-angle glaucoma who initially were prescribed one of three prostaglandins and 103 physicians participating in the same medical plans.
Methods
A structured interview addressing self-reported adherence, experiences with medication, communication with the physician, and health-related beliefs associated with adherence behavior was administered to surveyed patients. Phone interviews were conducted with participating ophthalmologists.
Main Outcome Measure
Of adherence, medication possession ratio.
Results
Eight variables were associated independently with a lower medication possession ratio: (1) hearing all of what you know about glaucoma from your doctor (compared with some or nothing); (2) not believing that reduced vision is a risk of not taking medication as recommended; (3) having a problem paying for medications; (4) difficulty while traveling or away from home; (5) not acknowledging stinging and burning; (6) being nonwhite; (7) receiving samples; and (8) not receiving a phone call visit reminder. The multivariate model explained 21% of the variance.
Conclusions
These findings indicate that doctor–patient communications and health-related beliefs of patients contribute to patient adherence. Patient learning styles that are associated with less concern about the future effects of glaucoma and the risks of not taking medications are associated with lower adherence. Specifically, knowledge about potential vision loss from glaucoma is a critical element that tends to be missed by more passive doctor-dependent patients who tend to be poorly adherent. These findings suggest that educational efforts in the office may improve patient adherence to medical therapies.
8Department of Ophthalmology & Visual Sciences, University of Louisville School of Medicine, Louisville, Kentucky.
Correspondence to David S. Friedman, MD, PhD, 600 North Wolfe Street, Wilmer 120, Johns Hopkins Hospital, Baltimore, MD 21287.
Manuscript no. 2007-728.
Supported by an unrestricted grant from Pfizer. The funding organization participated in the design of the study; conducting the study; data collection; data management; data analysis; interpretation of the data; and preparation, review, and approval of the manuscript.
Drs Friedman, Quigley, and Hahn are paid consultants to PACE, Inc. on behalf of Pfizer. This relationship is managed on behalf of Drs Friedman and Quigley by the Johns Hopkins Committee on Conflict of Interest. Dr Kim and Ms Shah are employees of Pfizer. At the time the research was conducted, both Mr Tan and Ms Gelb were employed by HealthCore, where Mr Tan remains employed. HealthCore is a consultancy whose activities on the project were funded by Pfizer, as are Ms Gelb's at present. Dr Zimmerman is a consultant to PACE and Pfizer.
ABSTRACT