Predictors of Adherence to Glaucoma Treatment in a Multisite Study
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ORIGINAL ARTICLE
Predictors of Adherence to Glaucoma Treatment in a Multisite Study Paul F. Cook, PhD & Sarah J. Schmiege, PhD & Steven L. Mansberger, MD & Jeffrey Kammer, MD & Timothy Fitzgerald, MA, PhD & Malik Y. Kahook, MD
# The Society of Behavioral Medicine 2014
Abstract Background Poor adherence hinders glaucoma treatment. Studies have identified demographic and clinical predictors of adherence but fewer psychological variables. Purpose We examined predictors from four health behavior theories and past research. Methods In the baseline phase of a three-site adherence study, before any intervention, 201 participants used electronic Medication Event Monitoring System (MEMS) bottles to monitor eyedrop use for 2 months, and completed questionnaires including self-reported adherence. Results MEMS showed 79 % adherence and self-report 94 % (0.5–1.5 missed weekly doses), but they correlated only rs = 0.31. Self-efficacy, motivation, dose frequency, and nonminority race/ethnicity predicted 35 % of variance in MEMS. Cues to action, self-efficacy, and intention predicted 20 % of variance in self-reported adherence. Conclusions Self-efficacy, motivation, intention, cues to action, dose frequency, and race/ethnicity each independently predicted adherence. Predictors from all theories were supported in bivariate analyses, but additional study P. F. Cook (*) : S. J. Schmiege University of Colorado College of Nursing, University of Colorado, Campus Box C288-04, Aurora, CO 80045, USA e-mail: [email protected] S. L. Mansberger Devers Eye Institute, Portland, OR 97210, USA J. Kammer Vanderbilt Eye Institute, Nashville, TN 37232, USA T. Fitzgerald Merck & Co., Inc., White House Station, NJ, USA M. Y. Kahook University of Colorado School of Medicine, University of Colorado, Aurora, CO 80045, USA
is needed. Researchers and clinicians should consider psychological predictors of adherence. (ClinicalTrials.gov ID# NCT01409421.) Keywords Attitude . Glaucoma . Medication adherence . Motivation . Theory
Introduction Glaucoma is a chronic, irreversible, optic neuropathy that can lead to permanent vision loss; it is the second leading cause of blindness worldwide and affects up to 60 million people [1]. Eye drop medications are prescribed to preserve visual function and quality of life by reducing intraocular pressure (IOP), and regular eye drop use reduces the rate of glaucoma progression [2]. However, nonadherence is an ongoing barrier to glaucoma treatment [3, 4], with more than half of patients remaining nonadherent even after significant vision loss [5]. Adherence has been estimated at 71 % after 2 months based on electronic monitoring [6], 50 % after 12 months based on population-level pharmacy data [7], and 64 % after 22 months based on pharmacy data in the large-scale glaucoma adherence and persistency study (GAPS; 4). GAPS also identified predictors of nonadherence based on chart reviews and telephone interviews for a subset of patients. Patient-level predictors of nonadherence included cost of treatment, lack of a po
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