Glaucoma medication noncompliance in

PalestineDr. Riyad Banayot

Purpose

To determine patient characteristics

Estimate the magnitude of noncompliance with glaucoma treatment

Estimate the determinants of noncompliance with glaucoma treatment

Methods

An interview was conducted with all glaucoma patients attending their regular follow-up visit over a 3-month period

A questionnaire was filled.

Noncompliance definition

Missing at least 1 drop per week and / or

Irregularity of doctor visits (< twice per year) and / or

Inability to accurately describe one’s medication routine

Patient Profile

Age Groups

10% 5%

24%

20%

32%

7%

2%

< 40 y 40-49 50-59 60-6970-79 80-89 90 & above

Sex

Education5%

39%

27%

2%

24%

2%

College IlliteratePrimary Read & writeSecondary University & higher

Glaucoma Duration

< 5y > 5 - 10y > 10 - 15y > 15y0%

10%

20%

30%

40%

50%

60%

70%

68%

12%

5%

15%

Visual Field

Mild Moderate severe Not done0%

5%

10%

15%

20%

25%

30%

35%32%

10%

24%

34%

Mean Deviation (MD): Mild (< - 6 dB); Moderate (- 6 to -12 dB); Severe (> - 12 dB)

Number of drops

One Two Three0%

10%

20%

30%

40%

50%

60%

37%

51%

12%

Do you have Medical insurance

NO

MO

H

UN

RWA

0%10%20%30%40%50%60%70%80%

9%

73%

18%

Cost of Drops

High cost

Low cost

Not an issue

0%

10%

20%

30%

40%

50%

60%

70%

80%

90% 85%

2%

12%

up to 100

100-200 200-30028%

29%

30%

31%

32% 32% 32%

29%

Who administers the drops

AuntChild Se

lf

Siblin

g

Spouse

0%

10%

20%

30%

40%

50%

60%

2%

27%

57%

5% 5%

Most common Difficulties/problems in taking drops

Cause S/E Hard to pay Drops fall on cheek

0%

10%

20%

30%

40%

50%

60%

70%

80%

54%

76%

44%

Why do you need someone to put drops?

Most common answer

Difficulty getting drops in my eye

17 %

Reported vs. documented

noncompliance

Take drops last week?

Never missed Days

Never missed Doses

Never missed Drops

78%

80%

82%

84%

86%

88%

90%

92%

85%

90%

83%

Documented !

0%

10%

20%

30%

40%

50%

49%

17% 15%

32%

10%

Documented !

Filtration 2000, on Rx since

Not using drops as prescribed

Puts >1 drop in eye

Uses drops as sees fit

Using different drops each visit

Using drops according to fasting hours

Using drops BE (Given drops for LE)

Using drops BE (LE IOP always high)

Using drops in wrong eye

Using drops LE (Given drops for BE)

Claims drops lasts 4 months

Claims some drops NA

Denies has glaucoma

Does not recognize drops

Missing drops

Most common cause:

Drops were finished

12 %

Make visits Noncomplianton-time

No

Som

etim

es

Yes. A

lway

s0%

10%20%30%40%50%60%70%80%90%

7% 12%

80%

0%

5%

10%

15%

20%

25%22%

Reason for not visiting on-time

Most common:No moneyOut of country Sick

Observed drop recognition

Recognize dropsDoes not recognize drops

0%10%20%30%40%50%60%70%80%90% 84%

16%

Technique:Observation Contamination

Missing

eye

No on

e with

pat

ient

On ta

rget

0%

20%

40%

60%

80%

7% 10%

83%

No Yes0%

10%

20%

30%

40%

50%

60%

70%

37%

63%

Close punctum Wait 3 min

0%10%20%30%40%50%60%70%80%90%

88%

3%10%

No Yes0%

10%

20%

30%

40%

50%

60%

70%

80%

80%

20%

Conclusion

We have to recognize that our Glaucoma patient are not compliant with their :DropsAppointment

We need to teach patients about:Glaucoma diseaseDrops and their side effectsAdministration technique of dropsBenefits of compliance with medication and F/U

visits