Monday, February 12, 2007

Section 12-B(1): Factors Affecting Adherence

1) Forgetfulness or Physical Limitations. Many patients report forgetfulness as one of the major reasons that they are not 100% adherent with their glaucoma medications. It is often difficult to incorporate a new drug regimen into one’s lifestyle.

2) Physical Limitations. Those with physical limitations, such as severe arthritis or significant visual disability, may have problems self-administering medications. Family or caregivers can help treat glaucoma by accompanying the patient to appointments, understanding the disease, and learning how to administer eye drops if necessary.

3) Misunderstanding the Disease and Its Treatment. This factor is easily corrected by gathering information about the disease process. Information on glaucoma is readily available at your eye doctor’s office, the library, book stores, and the internet (e.g. http://www.medrounds.org/glaucoma-guide/2006/02/table-of-contents-patients-guide-to.html). These available resources are inexpensive and easily obtained.

4) Multiple Doses Per Day. The number of doses per day and number of medications can also affect adherence. The more doses or medications prescribed, the less likely that there will be perfect adherence. Instilling numerous doses or medications can adversely affect a patient’s lifestyle. It is difficult to remember multiple drops and take time to administer eye drops throughout the day. The more frequently this occurs, the more likely there will be missed doses. Given the time necessary and other methods involved with ensuring proper glaucoma medications, it is easy to see why patients prefer once daily-dosed eye drops. The following eye drops are administered once daily: Xalatan, Travatan, Lumigan, Timolol XE, Istalol.

5.) Multiple Medications. One can improve adherence by minimizing the dosage and total number of medications that are still effective. Patients should be on the least number of eye drops necessary with the least dosing per day to control their glaucoma. Written instructions from the doctor’s office are a good reminder to be used at home, particularly for those on multiple systemic medications for other diseases. Combination eye drops [e.g., Cosopt (timolol/dorzolamide)] also exist which minimizes the number of eye drop bottles.

6.) Difficulty Administering Medications. Eye drop delivery aids are available for people who have physical difficulty administering their eye medications. The bottle can be placed in these devices, and the device allows the patient to easily squeeze the bottle in the correct position over the eye. One eye medication, Travatan, offers an aid which electronically monitors doses and offers reminders when doses are due (Figure 12-1). This aid allows providers to download the information to see how adherent a patient has been since their last visit.

Fig12-1

Figure 12-1. The Travatan Dosing Aid (Alcon, Ft Worth, TX) reminds patients when doses are due. It also allows the eye doctor to download information about the doses taken and their timing.

7.) Intolerable Side Effects. In general, topical glaucoma eye drops are well-tolerated, especially with the newer generation of medications. Nevertheless, some people can experience untoward side effects. The various medications and the side effects are numerous and have been discussed previously (see Chapter 7).

8.) High Cost of Medications. In a 3-year review (1998 to 2000) analyzing the medication cost, the following was the cost of glaucoma medication per year (Table 12-1).

Table 12-1. Average cost of glaucoma medication per year (1998-2000)

Cosopt

$470

Betoptic-S

$370

Xalatan

$352

Trusopt

$288

Alphagan

$273

Azopt

$243

Timoptic-XE

$190

Ocupress

$183

Generic levobunolol

$138

Optipranolol

$135

Generic timolol

$133

Patients are sometimes willing to pay more for medications which increase convenience and cause minimal side effects. Others are constrained by the cost, especially when they are taking other medications for systemic diseases.



Previous page Next Page

Table of Contents Title Page

0 Comments:

Post a Comment

Links to this post:

Create a Link

<< Home