Glaucoma patient expression of medication problems and nonadherence

Glaucoma is an incurable chronic eye disease that affects over 2 million people in the United States.1 As the U.S. population continues to age, glaucoma is projected to affect over 3 million people by 2020.1 To prevent or delay the progression of glaucoma, intraocular pressure-lowering medication eye drops are typically prescribed for life-long use. These medications are effective in slowing the progression of glaucoma; however, their effectiveness depends on patient adherence to the prescribed medication regimen. Research has found medication adherence to be a significant problem in the glaucoma patient population.2–4 Barriers to glaucoma medication adherence include: medication side effects, difficulty with eye drop administration, low health literacy skills, depressive symptoms and complex medication regimens.5–9 In order for physicians to address these barriers to adherence, patients must express their specific problems and concerns during their medical encounters. There is limited literature on the relationship between patient characteristics and expression of medication side effects to an eye care provider. In a prior study, patients who were using adjunctive therapy for glaucoma were surveyed to examine patient-reported problems and found that 60% of them expressed at least one problem with their medication.10 Difficulty with eye drop administration was the most commonly cited problem.10 Younger patients were more likely to report problems with side effects and females were more likely to report problems with eye drop administration.10 There have been additional studies investigating a similar relationship in other chronic disease states. Sleath et al. found that younger and non-Hispanic white patients were more likely to express a complaint about their antidepressant medications than older and Hispanic patients.11 The most commonly expressed complaints were medication side effects and lack of medication efficacy.11 In another study, investigators examined the extent of patient-expressed complaints with their chronic disease medication regimens.12 The most commonly expressed complaints included: medication side effects, medication not working, medication expense, having to take the medication, and having to use generic rather than brand named medication.12 This study found that patients were significantly more likely to express complaints about their medication regimen to younger physicians, and physicians were more likely to change the patient’s medication regimen if a problem was expressed.12 Similarly, there are few studies that examine the relationship between patient characteristics and an expression of medication non-adherence to an eye care provider. It is not clear what glaucoma patient characteristics are associated with an expression of non-adherence to an eye care provider. Sleath et al. found patients who expressed one or more complaints about their medication regimen to their physician were twice as likely to express an adherence problem as compared with patients who did not.13 Additionally, patients reporting difficulty with eye drop administration were more likely to report lower rates of adherence.13 Another study found that 14% of patients receiving adjunctive therapy for glaucoma reported problems with medication adherence.10 That study also found patients who reported medication problems were more likely to be non-adherent to their medications in the prior week.10 It is important for providers to understand which patient characteristics are associated with patient expression of medication problems and non-adherence so that they can collaborate with the patient to find a medication regimen, or alternative treatment plan (e.g., surgery) that mitigates the patient’s problems or concerns. In turn, this may help glaucoma patients become more adherent to their glaucoma medication. To our knowledge, no one has assessed what specific glaucoma patient characteristics are associated with patient expression of medication problems or medication non-adherence during clinic visits. The purpose of the paper was to evaluate what patient characteristics lead patients to express: (1) medication problems, including difficulty with side effects and eye drop administration, and (2) problems with non-adherence to glaucoma medications.