Adherence with topical glaucoma medication monitored electronically the Travatan Dosing Aid study.

Abstract

PURPOSE:

To assess patient adherence and behaviors with topical once-daily therapy for glaucoma.

DESIGN:

Prospective, observational cohort study.

PARTICIPANTS:

One hundred ninety-six patients with glaucoma who were being treated with a prostaglandin analog in 1 or both eyes at the Scheie or Wilmer Eye Institutes between August 2006 and June 2007.

METHODS:

Detailed medical history was obtained from each patient. All subjects used the Travatan Dosing Aid (DA; Alcon, Fort Worth, TX) to administer travoprost as prescribed. Devices were collected at 3 months and the data of drop usage was downloaded using software provided with the dosing aid. Data were analyzed for the 8-week period starting 2 weeks after the enrollment visit and ending 2 weeks before the 3-month visit.

MAIN OUTCOME MEASURES:

Assessment of adherence and patterns of drop usage as indicated by the DA.

RESULTS:

A total of 282 subjects consented to be in the study and 86 (30%) withdrew before study completion or had device errors, leaving 196 subjects (70%) with evaluable data at 3 months. The overall mean (+/-standard deviation) adherence rate was 0.71 (+/-0.24), ranging from 0.02 to 0.97. One hundred nine of these patients (55.6%) took greater than 75% of the expected doses. Those with adherence of less than 50% of expected doses showed substantially increased dose taking immediately after the office visit and just before the return visit at 3 months (P = 0.03). The mean adherence rate estimates of the physician and patient self-report were 0.77 and 0.95, respectively. The agreement between the physician assessment and DA-recorded adherence rate showed poor correlation for individual cases (intraclass correlation coefficient, 0.09; 95% confidence interval, 0.00-0.19).

CONCLUSIONS:

Nearly 45% of patients using an electronic monitoring device who knew they were being monitored and were provided free medication used their drops less than 75% of the time. Patients reported far higher medication use than their actual behavior. The ability of the physician to identify which persons are poorly adherent from their self-report or from other subjective clues is poor.

FINANCIAL DISCLOSURE(S):

Proprietary or commercial disclosure may be found after the references.

• Authors: Constance O Okeke, Harry A Quigley, Henry D Jampel, Gui-shuang Ying, Ryan J Plyler, Yuzhen Jiang, David S Friedman
• Journal: Ophthalmology (Ophthalmology) Vol. 116 Issue 2 Pg. 191-9 (Feb 2009) ISSN: 1549-4713 [Electronic] United States
• PMID: 19084273 (Publication Type: Journal Article, Multicenter Study, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Antihypertensive Agents
• Ophthalmic Solutions
• Cloprostenol
• Travoprost

Topics

• Administration, Topical
• Adult
• Aged
• Aged, 80 and over
• Antihypertensive Agents (administration & dosage)
• Attitude to Health
• Cloprostenol (administration & dosage, analogs & derivatives)
• Cohort Studies
• Drug Monitoring (instrumentation)
• Female
• Follow-Up Studies
• Glaucoma, Angle-Closure (drug therapy)
• Glaucoma, Open-Angle (drug therapy)
• Humans
• Intraocular Pressure (drug effects)
• Male
• Middle Aged
• Ocular Hypertension (drug therapy)
• Ophthalmic Solutions (administration & dosage)
• Patient Compliance (statistics & numerical data)
• Prospective Studies
• Surveys and Questionnaires
• Travoprost