Risk Factors for Poor Adherence to Eyedrops in Electronically Monitored Patients with Glaucoma
Received 11 August 2008; received in revised form 14 January 2009; accepted 20 January 2009. published online 20 April 2009.
Purpose
To identify risk factors for poor adherence to topical once daily therapy for glaucoma.
Design
Prospective, observational cohort study.
Participants
A total of 196 patients with glaucoma who were being treated with a prostaglandin analog in 1 or more eyes at the Scheie or Wilmer Eye Institutes between August 2006 and June 2007.
Methods
Demographics, ocular history, and responses to interview questions about glaucoma knowledge, health beliefs, and drop-taking behaviors were obtained from each patient. All patients used the Travatan Dosing Aid (DA; Alcon Laboratories Inc., Fort Worth, TX) to administer travoprost as prescribed. Devices were collected at 3 months, and the data of drop use were downloaded using software provided with the DA. Patients taking ≤75% doses during the 8-week period starting 2 weeks after the enrollment visit and ending 2 weeks before the 3-month visit were compared with those taking >75% of doses.
Main Outcome Measures
Risk factors for poor adherence.
Results
Eighty-seven patients (44.4% of the 196 subjects with evaluable data at 3 months) used the DA on 75% or less of the monitored days. In univariate analysis, poorer adherers were more likely to be <50 or ≥80 years of age, to be African American, to report less than excellent health, to report higher amounts of depression, to have lower income, and to be treated at the Scheie Eye Institute. Multivariate analysis (adjusting for education and income) found that age, race/ethnicity, and less than excellent health were associated with poor adherence.
Conclusions
Those who failed to take more than 75% of eyedrop doses were more likely to be African American and to report poor health. Those in the youngest and oldest age groups were less adherent, although this finding was not always statistically significant. Further research into the factors driving these associations and into developing predictive models to assist in screening for low adherence are warranted.
Financial Disclosure(s)
Proprietary or commercial disclosure may be found after the references.
Available online: April 19, 2009.
1Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
2Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
3Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
4Department of Preventive Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
Correspondence: David S. Friedman, MD, MPH, PhD, Wilmer Eye Institute, Wilmer 120, 600 North Wolfe Street, Baltimore, MD 21210
Manuscript no. 2008-964.
Financial Disclosure(s): The author(s) have made the following disclosure(s):
Drs. Friedman and Quigley are paid consultants for and have received honoraria or research support from Alcon. Dr. Jampel is a consultant for Allengan, Ivantis, and Glaucos. No conflicting relationship exists for any other authors.
Supported in part by PHS Research Grants EY01765 (Core Facility Grant, Wilmer Institute), NIH K12 EY015398, (Dr. Okeke), a grant from The Paul and Evanina Bell Mackall Foundation Trust (Dr. Okeke), and an unrestricted gift from Alcon, Inc.
ABSTRACT