Spencer Sascha K R, Shulruf Boaz, McPherson Zachary E, Zhang Helen, Lee Mitchell B, Francis Ian C, Bank Allan, Coroneo Minas T, Agar Ashish
The University of New South Wales, Sydney, NSW, Australia; Prince of Wales Hospital, Sydney, NSW, Australia.
The University of New South Wales, Sydney, NSW, Australia.
Ophthalmol Glaucoma. 2019 Mar-Apr;2(2):86-93. doi: 10.1016/j.ogla.2019.01.006. Epub 2019 Jan 26.
To assess which factors in the lives and disease of patients with glaucoma affect their adherence to topical glaucoma therapy and the quantitative significance of this effect. To assess qualitatively the most influential barriers to adherence from the perspective of the patient.
Multicenter, prospective, cross-sectional pilot study.
A total of 145 patients, attending outpatient metropolitan glaucoma clinics in Sydney, Australia, who were prescribed topical glaucoma medications.
A structured interview-based questionnaire was conducted with 145 individuals using glaucoma eye drops that had been prescribed at least 2 weeks previously. The questionnaire involved 2 novel questions on adherence, 29 questions on factors identified or postulated in the literature as affecting adherence for quantitative analysis, and 1 open-response question on patient-identified causes of nonadherence for qualitative analysis. This questionnaire represents the broadest coverage of factors hypothesized to affect adherence in a single study in the glaucoma medication adherence literature to date.
Adherence rate, risk factors for poor adherence, and patient-identified barriers to adherence.
In response to the question "How many days have you missed a drop in the last 2 weeks," 69.7% of patients reported total adherence. Four factors were significantly related to an increased likelihood of reporting having missed drops in the last 2 weeks. These were difficulty applying drops (odds ratio [OR], 2.35; 95% confidence interval [CI], 1.02-5.44; P < 0.05), a past or current diagnosis of depression (OR, 3.61; 95% CI, 1.53-8.52; P < 0.01), patient self-rating of own memory ≤ 7 of 10 (OR, 3.15; 95% CI, 1.36-7.30; P < 0.01), and self-reported motivation score ≤ 6 of 10 (OR, 10.94; 95% CI, 3.00-39.81; P < 0.01). Patient understanding of glaucoma, ethnicity, and socioeconomic status were among the 25 factors found not to have a statistically significant correlation with adherence.
There is a significant proportion of patients taking their topical glaucoma medications less often than prescribed. Adherence to topical glaucoma therapies is negatively correlated to several factors: difficulty applying drops, a past or current diagnosis of depression, poor self-rating of own memory, and poor self-rating of own motivation. These may prove useful in designing interventions to improve adherence in these patients.
评估青光眼患者生活与疾病中的哪些因素会影响其对局部青光眼治疗的依从性，以及这种影响的定量意义。从患者角度定性评估影响依从性的最具影响力的障碍。
多中心、前瞻性、横断面试点研究。
总共145名在澳大利亚悉尼的大都市青光眼门诊就诊且被开具局部青光眼药物的患者。
对145名使用至少在2周前就已开具的青光眼眼药水的患者进行了基于结构化访谈的问卷调查。该问卷包含2个关于依从性的新问题、29个关于文献中确定或推测的影响依从性的因素用于定量分析，以及1个关于患者自行确定的不依从原因的开放式问题用于定性分析。这份问卷代表了在青光眼药物依从性文献的单一研究中，对假设影响依从性的因素最广泛的涵盖。
依从率、依从性差的风险因素以及患者自行确定的依从性障碍。
对于“在过去2周内你有多少天漏滴眼药了”这个问题，69.7%的患者报告完全依从。有4个因素与报告在过去2周内漏滴眼药的可能性增加显著相关。这些因素分别是滴眼困难（优势比[OR]，2.35；95%置信区间[CI]，1.02 - 5.44；P < 0.05）、过去或当前诊断为抑郁症（OR，3.61；95% CI，1.53 - 8.52；P < 0.01）、患者对自己记忆力的自评≤7分（满分10分）（OR，3.15；95% CI，1.36 - 7.30；P < 0.01），以及自我报告的动机得分≤6分（满分10分）（OR，10.94；95% CI，3.00 - 39.81；P < 0.01）。患者对青光眼的了解、种族和社会经济地位是发现与依从性无统计学显著相关性的25个因素中的一部分。
有相当比例的患者使用局部青光眼药物的频率低于医嘱。局部青光眼治疗的依从性与几个因素呈负相关：滴眼困难、过去或当前诊断为抑郁症、对自己记忆力的自评差以及对自己动机的自评差。这些可能对设计改善这些患者依从性的干预措施有用。
