Prescription pattern of ocular hypotensive drugs in Portugal and its comparison with the European guidelines – PEM study

Abstract

PurposeThere are few studies in Europe addressing the adherence to antiglaucomatous prescription guidelines. This study aims to describe the nationwide yearlong analysis of the prescription patterns of these drugs in Portugal, discussing how guidelines are being applied and identifying opportunities for improvement.MethodsCross‐sectional study including all patients who were prescribed at least one IOP‐lowering medication in Portugal, in 2015. Data was obtained from the common electronic drug prescription system used by all hospitals and clinics in the country. Current National and European Guidelines on Glaucoma Management were used as a reference. Statistical analyses were performed using STATA.ResultsA total of 833 871 prescriptions were provided to 231 634 patients (57% women). Over half of them were under monotherapy, but only 76% complied with first‐line treatment choices (prostaglandin analogues or beta blockers). Among patients who were prescribed two IOP‐lowering drugs, only two thirds adhered to the treatment strategy of using them as a fixed combination (FC). The guidelines orientation to use FC treatments was more likely to be followed by the ophthalmologist than the patient's General Practitioner. Nationwide, this topical IOP‐lowering therapy accounted for a total of 26 million euros (M€) in costs, shared between patients and the national health system. The prescription rate per 100 000 people ranged from 13 180 to 2 257 among the seven Portuguese regions.ConclusionsGuidelines for glaucoma treatment seem to apply to the majority of Portuguese patients taking IOP‐lowering medication. However, a significant number of treated patients are not being prescribed first line IOP‐lowering drugs. Non‐ophthalmologist may be less aware of the preferred practice patterns in the management of this disease.