Cohen Castel Orit, Keinan-Boker Lital, Geyer Orna, Milman Uzi, Karkabi Khaled
Division of Family Medicine, Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa,
Faculty of Social Welfare and Health Sciences, School of Public Health, University of Haifa, Haifa.
Fam Pract. 2014 Aug;31(4):453-61. doi: 10.1093/fampra/cmu031. Epub 2014 Jun 12.
Primary open-angle glaucoma is a leading cause of irreversible blindness.
To identify factors associated with adherence to glaucoma pharmacotherapy in the primary care setting, focusing on physicians' role.
Patients were recruited from primary care clinics and telephone-interviewed using a structured questionnaire that addressed patient-, medication-, environment- and physicians-related factors. Patients' data on pharmacy claims were retrieved to calculate the medication possession ratio for measuring adherence.
Seven hundred thirty-eight glaucoma patients were interviewed. The multivariate analysis identified eight variables that were associated independently with adherence. Barriers to adherence were found to be low income, believing that 'It makes no difference to my vision whether I take the drops or not' and relying on someone else for drop instillation (exp(B) = 1.91, P = 0.002; exp(B) = 2.61, P < 0.0001; exp(B) = 2.17, P = 0.001, respectively). Older age, having a glaucoma patient among close acquaintances, taking a higher number of drops per day, taking a prostaglandin drug and reporting that the ophthalmologist had discussed the importance of taking eye drops as prescribed, were found to promote adherence (exp(B) = 0.96, P < 0.0001; exp(B) = 0.54, P = 0.014; exp(B) = 0.81, P = 0.001; exp(B) = 0.37, P < 0.0001; exp(B) = 0.60, P = 0.034, respectively). No association was found between the patient's relationship with the family physician and adherence to glaucoma treatment.
Adherence to glaucoma pharmacotherapy is associated with patient-related, medication-related, physician-related and environmental factors. Ophthalmologists have a significant role in promoting adherence. However, the potential role of family physicians is unfulfilled and unrecognized.
原发性开角型青光眼是不可逆性失明的主要原因。
确定基层医疗环境中与青光眼药物治疗依从性相关的因素，重点关注医生的作用。
从基层医疗诊所招募患者，并使用结构化问卷进行电话访谈，该问卷涉及患者、药物、环境和医生相关因素。检索患者的药房报销数据以计算药物持有率来衡量依从性。
对738名青光眼患者进行了访谈。多变量分析确定了八个与依从性独立相关的变量。发现依从性的障碍包括低收入、认为“我滴不滴眼药对视力没影响”以及滴眼药依赖他人（分别为exp(B)=1.91，P=0.002；exp(B)=2.61，P<0.0001；exp(B)=2.17，P=0.001）。年龄较大、亲密熟人中有青光眼患者、每天滴眼药次数较多、使用前列腺素类药物以及报告眼科医生已讨论按处方滴眼药的重要性，这些因素被发现可促进依从性（分别为exp(B)=0.96，P<0.0001；exp(B)=0.54，P=0.014；exp(B)=0.81，P=0.001；exp(B)=0.37，P<0.0001；exp(B)=0.60，P=0.034）。未发现患者与家庭医生的关系与青光眼治疗依从性之间存在关联。
青光眼药物治疗的依从性与患者相关、药物相关、医生相关和环境因素有关。眼科医生在促进依从性方面具有重要作用。然而，家庭医生的潜在作用未得到发挥和认可。
