Tailored education key to glaucoma medication adherence

Is patient adherence to glaucoma medication overwhelmingly affected by a single issue or does each person have a unique set of barriers to address? According to this survey, to improve adherence you need to take the time to tailor education to each patient’s particular needs.

The authors asked 190 glaucoma patients about 11 common barriers to medication adherence and found that all 11 were significant to at least 30% of patients, with most patients (62%) citing more than 1 barrier as significant.

Forgetfulness, poor self-efficacy (low motivation) and difficulty with drop administration or medication schedule were the most common barriers to adherence. For each additional barrier a patient listed as significant, the risk of nonadherence increased by 10%.

Surprisingly, half of both adherent and nonadherent patients were skeptical that glaucoma causes vision loss and that medication can mitigate vision loss. The authors note that openly discussing patient beliefs about the disease could help improve adherence and patient satisfaction overall.

For both adherent and nonadherent patients, forgetfulness was the number 1 barrier to adherence. The authors urge health care providers to probe deeper into forgetfulness because it may encompass many different issues. Forgetfulness may be perceived as more socially acceptable than other barriers, such as not believing that glaucoma medications are really helping prevent vision loss. It may be easier for patients to say that they forgot to take their medication than to discuss issues that could be seen as confrontational.

The authors also suggest a style of counseling called motivational interviewing to build patients’ sense of self-efficacy. Ask patients to come up with ideas on how to overcome issues they face when taking their medication and then offer advice that other patients have found helpful.

Tailored education has been shown to be more effective than standard health education across many diseases that require people to engage in consistent health behaviors, from quitting smoking to managing diabetes. Knowing which barriers your patients find significant may be the key to improving adherence.