Abstract
This study determined the degree of adherence to medications for glaucoma among patients refilling prescriptions in community pharmacies. Methods: Data abstracted from the dispensing records for 3615 adult patients (18 years or older, predominantly over 45) receiving glaucoma medications from two retail pharmacy chains (64 stores in total) were analyzed. From a 24-month historic data capture period, the 12-month levels of adherence were determined using standard metrics, the proportion of days covered (PDC) and the medication possession ratio (MPR). The overall 12-month mean PDC was only 57%, and the mean MPR was 71%. Using a criterion by which 80% coverage was considered satisfactory adherence, only 30% had satisfactory overall 12-month PDC coverage, and only 37% had satisfactory overall 12-month MPR coverage. Refill adherence increased with age and was highest in the 65-and-older age group (p < 0.001). Differential adherence was found across medication classes, with the highest satisfactory coverage seen for those taking alpha2-adrenergic agonists (PDC = 36.0%; MPR = 47.6%) down to those taking direct cholinergic agonists (PDC = 25.0%; MPR = 31.2%) and combination products (PDC = 22.7%; MPR = 31.0%). Adherence to glaucoma medications in the community setting, as measured by pharmacy refill data, is very poor and represents a critical target for intervention. Community pharmacists are well positioned to monitor and reinforce adherence in this population.
Highlights
Medication non-adherence is recognized as one of the most important and costly worldwide healthcare problems in the 21st century [1]
Non-adherence to glaucoma medications has been estimated to range from 24% to 59%; in a study of claims data, 50% of patients stopped taking their medications within six months, and only 37% had their prescriptions filled three years after initial dispensing [4]
The majority were predominately women (57%), and, as glaucoma is a disease of older age, the majority were over the age of 65 (69%), compared with 23% in those aged 45–64 years and only 8% in those aged 18–44 years
Summary
Medication non-adherence is recognized as one of the most important and costly worldwide healthcare problems in the 21st century [1]. Med. 2016, 5, 79 is reversible [3]. The only proven method of slowing glaucoma is to lower intraocular pressure (IOP) with daily medications for an indefinite period [4]. Ocular disorders such as glaucoma are recognized to be amongst the top five conditions, where progression is related to poor patient adherence [5]. Non-adherence to glaucoma medications has been estimated to range from 24% to 59%; in a study of claims data, 50% of patients stopped taking their medications within six months, and only 37% had their prescriptions filled three years after initial dispensing [4]. According to Schwartz and Quigley, research brings the “unwelcome conclusion that persistence with initial glaucoma medication is as low as 33%–39% at one year” [7]
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