Monday, February 12, 2007

Section 12-B(2): Measures to Improve Adherence to Glaucoma Medications

  • Understand the Disease and Its Treatment. Patients are encouraged to ask questions about their diagnosis and understand the rationale behind its treatment. Obtain information on the disease from the prescribing provider, books, and online glaucoma sites (e.g. http://www.medrounds.org/glaucoma-guide/2006/02/table-of-contents-patients-guide-to.html).

  • Prescribing Least Number of Medications/Doses. Adherence can be improved by using the least number of medications and least number of doses per day to control glaucoma

  • Minimize Untoward Side Effects. Report adverse side effects from eye drops. Understand the expected side effects and identify which ones are not transient. Some medications may cause slight redness upon initial instillation of the drop which improves with time.
  • Get Written Instructions. Written instructions are helpful for the patient to recall the exact medical regimen prescribed by the eye doctor (Figure 12-2). Relying only on verbal instructions often leads to mistakes in administration of medications. It is difficult for the patient to remember all verbal instructions when there is so much information given during a clinic visit.

fig12-2a

fig 12-2b

Figure 12-2. A medication instruction sheet is a helpful reminder to take medications as exactly prescribed (Click on image above for larger, pdf, version. © University of Iowa).

  • Use Colors to Identify Correct Medications. It is important to know what medications are prescribed, what they do, and how to correctly identify them. The bottles cap color provides a helpful reminder of what each bottle contains (see Chapter 7, Table 7-2).
  • Practice Administering Medications in the Clinic. Patients are encouraged to practice administering eye drops under the supervision of their eye doctor. This allows the eye doctor to see how well a patient is instilling their medications. It also reassures the patient that their instillation technique is correct.
  • Time Doses with Scheduled Activities. Dose eye drops with scheduled activities. Patients can often incorporate their medication in the morning, with meals, and at bedtime. Linking the eye drop with an activity, such as brushing teeth or taking other oral medications, is helpful.
  • Obtain Help from Family/Caregivers. Enlisting the help of others may be necessary for those who are unable to comprehend or self-administer eye drops. Family/caregivers’ understanding of the disease and its treatment is key to improving adherence to a prescribed drug regimen.
  • Perform Punctal Obstruction or Eyelid Closure. It is recommended that patients wait 15 minutes between medications to allow better absorption of each medication. If 3 eye drops have been prescribed, there would be 30 minutes of waiting time per dose. For example, if there are 3 medications that need to be taken twice daily each, more than 60 minutes of time is necessary to administer these medications each day. It is easy to see how an increase in the number of medications causes a decrease in adherence. Another method of improving absorption of eye drops is to use punctual occlusion. This maneuver allows the eye medication to absorb more effectively by obstructing the outflow from the eye. It is performed by placing digital pressure over the lower eyelid puncta by the nose (see Chapter 7, Figure 7-4, 7-5).
  • Use Eye Drop Delivery Aids If Necessary. Eye drop delivery aids could be useful in some patients. For those with arthritis or severe vision loss, it may be useful (Figure 12-3).

fig12-3

Figure 12-3. An eyedrop dispenser for Xalatan (Xal-Ease, Pfizer, NY, NY) can help those who have difficulty administering Xalatan eye drop.

  • Checking on Prescription Refills to Determine Adherence Level. Patients and eye doctors can check on the number of refills within a certain time period. This gives a general estimation to see if the usage seems on track.
  • Generics and Understanding Available Resources to Decrease Cost. Generic glaucoma medications are available which helps to defray some of the cost. The Glaucoma Research Foundation (http://www.glaucoma.org/) provides a section on financial aid and programs that assist patients with obtaining their glaucoma medications.


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