Pharmacoepidemiological assessment of adherence and influencing co-factors among primary open-angle glaucoma patients-An observational cohort study.

Stefanie Frech,Gabriele Doblhammer,Daniel Kreft,Rudolf F Guthoff

doi:10.1371/journal.pone.0191185

Abstract

The goal of this study was to assess the adherence of primary open-angle glaucoma (POAG) patients to medication, and to determine co-factors influencing adherence, using a representative sample of members of the largest German public health insurer. The observational cohort study was based on a longitudinal data set from 2010–2013 and included 250,000 insured persons aged 50 and older with 10,120 diagnosed POAG patients. Uni- and multivariate analysis was performed to investigate several aspects of glaucoma, such as prevalence, adherence, and co-factors influencing adherence. The main outcome measured adherence with prescriptions filled within a year. Multivariate panel regression analysis was used to determine the co-factors influencing this adherence. Prevalence of POAG was 3.36% [CI: 3.28–3.43%], with 2.91% [CI: 2.81–3.01%] for males and 3.71% [CI: 3.61–3.81%] for females, increasing with age. The mean level of adherence in terms of prescriptions filled was 66.5% [CI: 65.50–67.60%]. The results of this analysis revealed a significant influence of age, duration of the disease, care need, distance to death, and multimorbidity as co-factors of non-adherence, whereas gender had no influence. The analysis provided detailed information about POAG health care aspects concerning prevalence and adherence. The most endangered risk groups for non-adherence were patients aged 50–59, patients older than 80 years, patients with a longer duration of POAG, patients with care needs, and patients with three or more severe diseases in addition to glaucoma. To know the predictors responsible for an increased risk to develop POAG is of importance for all persons involved in health care management. Therefore effective strategies to increase awareness of patients and medical care personnel about non-adherence and the importance of a regular and continuous medication to avoid further nerve fiber damage and possible blindness have to be developed.

Highlights

Primary open-angle glaucoma (POAG) is a chronic and initially asymptomatic disease causing early irreversible nerve fiber damage
The quarterly individual-level data covered general demographic data, inpatient and outpatient diagnosis data coded by the International Classification of Disease 10th revision (ICD-10), medical treatment data coded by the German Procedure Classification (OPS), and prescriptions of medications coded by the German Anatomical Therapeutic Chemical (ATC)-Classification
Adherence indicated as proportion of filled prescriptions

Summary

Introduction

Primary open-angle glaucoma (POAG) is a chronic and initially asymptomatic disease causing early irreversible nerve fiber damage. Glaucoma is the second leading cause of blindness and primary open-angle glaucoma (POAG) is expected to affect 58.6 million people by 2020. In Europe, glaucoma prevalence is higher than 5% for patients aged 80 and older [3] but reaches much higher levels in other regions and populations of the world. An urban West African population study, the Tema Eye Survey, found POAG prevalence values of 6.8% for those aged 40 and older, increasing to 14.6% among those 80 years and older [4]. In the USA, the Salisbury Eye Evaluation Glaucoma Study determined prevalences of 3.4% for white individuals aged 73 and 74, and of 9.4% for people aged 75 years and older. Among black individuals the prevalence was 5.7% for those aged 73 and 74, increasing to 23.2% for people aged 75 and older [5]

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