Improving Patient Compliance For Better
the barriers to compliance will help you develop new strategies that will lead
to improved patient care.
By Judith Springer Riddle, Senior Editor
your glaucoma patients take IOP-lowering drugs as directed remains an uphill battle.
You'd like to assume your patients are taking their medications faithfully, but
many are not.
Although patient compliance to medical therapy
has improved somewhat, research shows only 75% of patients take ocular medications
A recent study by Shah found that 77%
of patients with open-angle glaucoma claimed to be fully compliant; only 23% said
they didn't take their medications consistently.2 But as doctors know
from experience, self-reporting is often inaccurate.
Adherence to glaucoma therapy is even
less likely when patients must use more than one medication, which is often the
In a study by Patel and Spaeth,3
patients who used only one glaucoma drug were 50% more adherent to medical therapy
compared with one-third of patients who used multiple drugs.
Consequences of poor compliance
When patients don't take their medications as
prescribed, the quality of care becomes compromised. If you do not know exactly
how patients are taking their medications, you can't make critical decisions about
dosing adjustments, adjunctive therapies or alternate treatment modalities.4
Noncompliant patients are more likely
to have uncontrolled IOPs and risk irreversible visual-field loss.
What's more, noncompliance leads to
higher out-of-pocket healthcare costs for patients when doctors have to prescribe
additional drugs and order invasive surgical procedures, such as
or filtration surgery, to slow disease progression.
Knocking down the barriers
Why don't patients take their glaucoma medications
as prescribed? Some say they choose to use the drugs occasionally to avoid side
Others skip their medications altogether
because they find it difficult to keep up with dosing schedules and to instill drops
in their eyes. Forgetfulness is the primary cause of patient noncompliance.3
Other issues include lack of patient education about the disease and poor understanding
of the consequences of not taking glaucoma drugs.
Improving the odds
Whatever reasons patients give for medical noncompliance,
you can take a proactive approach to improve adherence, starting with communication.
For instance, asking open-ended questions will help you find out how patients are
using their medications. But be mindful of how you ask these questions. Asking,
"Are you taking your medications?" may sound intimidating to some patients and will
only give you "yes" or "no" answers that may or may not be truthful. Encouraging
patients to "Tell me how you're using your medications" will spark a discussion
between you and your patients and reveal how much they know about glaucoma.
If they don't know enough, you can
use that opportunity to discuss the disease process, the rationale behind the treatment
regimens and why they're critical to preventing vision loss.
What's more, you can empathize with
patients' concerns about side effects and dosing schedules by choosing drugs that
are easier for them to use and by tailoring treatment regimens that fit their special
needs and limitations.
By using these and other methods to
improve communication, you should continue to see a gradual increase in medical
therapy compliance and much better visual outcomes.
What's next? New study results and
their clinical applications, which also should improve patient compliance and help
doctors better manage glaucoma.
1. DiMatteo RM. Variations in Patients' Adherence
to Medical Recommendations: A Quantitative Review of 50 Years of Research. Medical
2. Deokule S., Sadiq S., Shah S. Chronic
open angle glaucoma: patient awareness of the nature of the disease, topical medication,
compliance and the prevalence of systemic symptoms. Ophthal Physiol Opt 2004;24:9-15.
3. Patel, SC, Spaeth, GL. Compliance
in patients prescribed eye drops for glaucoma. Ophthalmic Surg. 1995;26:233-236.
4. Shaya, FT. Compliance with Medicine.
Ophthalmol Clin N Am. 2005;18:611-617.
Optometric Management, Issue: August 2006