2 JAMA Ophthalmology Studies Focus on Glaucoma Medication Adherence

Electronic Monitoring Documents Lack of Medication Adherence in Patients with Glaucoma   

Bottom Line: Electronic monitoring to measure medication adherence by patients with glaucoma documented that a sizable number of patients did not regularly use the eye drops prescribed to them.

Author:  Michael V. Boland, M.D., Ph.D., of the Wilmer Eye Institute at Johns Hopkins University, Baltimore, Md., and colleagues.

Background:  Topical medications for glaucoma lower intraocular pressure and can delay or slow the progression of the eye disease. Medication adherence is important.

How the Study Was Conducted: Patients who were treated with once-daily prostaglandin eye drops were recruited from a university-based glaucoma clinic. Patients were given a container with an electronic cap in which to store their eye drops. The cap recorded each time the container was opened.

Results:  Of the 407 patients who completed the three-month adherence assessment, 337 (82.8 percent) took their medication correctly on at least 75 percent of days. The other 70 patients (17.2 percent) (deemed nonadherent) were less likely to be able to name their glaucoma medication, less likely to agree that remembering to use the medication was easy, and more likely to agree with the sentiment that eye drops can cause problems.

Discussion: “Given that most patients are taking their eye drops as prescribed, identifying patients at risk of nonadherence is a critical step. The results from the patient questions and demographic factors may therefore be useful in creating risk calculators that could find those patients most in need of intervention.”

 (JAMA Ophthalmol. Published online May 15, 2014. doi:10.1001/.jamaopthalmol.2014.856.

Automated Text or Voice Messages Help Improve Glaucoma Medication Adherence 

Bottom Line: An intervention that included text or voice messages appeared to help patients with glaucoma adhere to their eye drop medication.

Author:  Michael V. Boland, M.D., Ph.D., of the Wilmer Eye Institute at Johns Hopkins University, Baltimore, Md., and colleagues.

Background:  The barriers to medication adherence by patients with glaucoma are complex. There is a growing body of work on improving adherence.

How the Study Was Conducted: The 70 nonadherent patients in the related study that assessed medication adherence were randomized to an intervention (n=38) or to a control group (n=32) where they received no additional intervention. The intervention consisted of daily messages, either text or voice, reminding patients to use their glaucoma medication. A personal health record was used to store lists of patient medications and reminder preferences.

Results: The median adherence rate in the 38 patients in the intervention increased from 53 percent to 64 percent. There was no change in the control group. Patients in the intervention (84 percent) agreed the reminders were helpful and that they would continue to use them outside the study. Implementing the intervention is estimated to cost about $20 per year per patient.

Discussion: “We found that a telecommunication-based reminder linked to a personal health record can increase adherence with once-daily glaucoma medications. This finding is important because it supports an intervention that is feasible in terms of time and cost for a typical ophthalmology practice.”

(JAMA Ophthalmol. Published online May 15, 2014. doi:10.1001/.jamaopthalmol.2014.857.