2.50
Hdl Handle:
http://hdl.handle.net/10755/211581
Type:
Research Study
Title:
GLAUCOMA MEDICATION TREATMENT NONADHERENCE: CORRELATES AND CONSEQUENCES
Abstract:
Purpose/Aims: As part of an ongoing multi-site randomized controlled trial (RCT) of motivational interviewing for glaucoma medication adherence, we explored psychosocial variables and outcomes related to nonadherence among older adults with glaucoma. Background: People fail to take glaucoma medication for various reasons, including cost, side effects, and believing that treatment is not helpful. Patient counseling to address such issues may be beneficial (Cook et al., 2010), but the specific factors that affect glaucoma adherence are not well understood. Better data on the relationships between psychosocial experiences, vision problems, overall health, and adherence can help to guide interventions. Methods: Persons with glaucoma (N = 25) were recruited from two eye clinics in Denver CO and Portland OR. Eligibility criteria were: (a) community-dwelling adults with open-angle glaucoma, (b) monotherapy glaucoma treatment, (c) visual field data available, (d) no plan for surgery within 6 months, and (e) no comorbidity that the patient’s physician believed would interfere with participation. Participants were older adults (M = 65 years, range: 44-84), 44% men, 44% non-White, 57% married, and 60% retired or disabled, with multiple comorbid conditions. Upon enrollment, participants completed validated paper-and-pencil measures of treatment motivation, knowledge, adherence, treatment satisfaction, self-efficacy, eye symptoms, functional impairment, vision, general health, social support, stress, coping, and anxiety. Adherence behavior was assessed with items on participants’ medication use over the past 3 days; barriers to adherence were assessed with the Morisky medication adherence scale plus items on specific barriers to adherence like side effects and drug use. All measures had adequate reliability (αs > .70). No intervention was given before data collection, so RCT groups were combined for analysis. Pearson correlations were used to analyze relationships, and reported if significant at the p < .05 level. Results: Self-reported adherence was high (M = 2.4/3, SD = 1.0), with 50% of participants reporting perfect adherence over the past 3 days and another 25% reporting adherence on 2 of the past 3 days. Nonadherence correlated with negative mood (r = .59). More functional impairment, lower self-efficacy, lower treatment motivation, more side effects, and any nonprescribed drug use all correlated with barriers to adherence based on the Morisky scale (rs > .47). However, none of these were related to actual adherence behavior, with only motivation (r = .39, p = .06) and Morisky score (r = -.35, p = .10) approaching significance. All other direct effects of psychosocial factors on adherence behavior were small (rs < .27). Adherence was related to better health (r = .42) and marginally related to satisfaction with glaucoma medication (r = .37 p = .10). General health was associated with vision quality, fewer eye symptoms, and less functional impairment (rs > .50), but adherence was not. Implications: People with glaucoma have high but variable self-reported adherence, and adherence is related to better health and treatment satisfaction. Providers should monitor patients’ adherence and potential barriers. Adherence barriers and adherence behavior are distinct constructs, with barriers showing stronger relationships to psychosocial variables.
Keywords:
Medication adherence; Glaucoma
Repository Posting Date:
20-Feb-2012
Date of Publication:
20-Feb-2012
Other Identifiers:
5520
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typeResearch Studyen_GB
dc.titleGLAUCOMA MEDICATION TREATMENT NONADHERENCE: CORRELATES AND CONSEQUENCESen_GB
dc.identifier.urihttp://hdl.handle.net/10755/211581-
dc.description.abstractPurpose/Aims: As part of an ongoing multi-site randomized controlled trial (RCT) of motivational interviewing for glaucoma medication adherence, we explored psychosocial variables and outcomes related to nonadherence among older adults with glaucoma. Background: People fail to take glaucoma medication for various reasons, including cost, side effects, and believing that treatment is not helpful. Patient counseling to address such issues may be beneficial (Cook et al., 2010), but the specific factors that affect glaucoma adherence are not well understood. Better data on the relationships between psychosocial experiences, vision problems, overall health, and adherence can help to guide interventions. Methods: Persons with glaucoma (N = 25) were recruited from two eye clinics in Denver CO and Portland OR. Eligibility criteria were: (a) community-dwelling adults with open-angle glaucoma, (b) monotherapy glaucoma treatment, (c) visual field data available, (d) no plan for surgery within 6 months, and (e) no comorbidity that the patient’s physician believed would interfere with participation. Participants were older adults (M = 65 years, range: 44-84), 44% men, 44% non-White, 57% married, and 60% retired or disabled, with multiple comorbid conditions. Upon enrollment, participants completed validated paper-and-pencil measures of treatment motivation, knowledge, adherence, treatment satisfaction, self-efficacy, eye symptoms, functional impairment, vision, general health, social support, stress, coping, and anxiety. Adherence behavior was assessed with items on participants’ medication use over the past 3 days; barriers to adherence were assessed with the Morisky medication adherence scale plus items on specific barriers to adherence like side effects and drug use. All measures had adequate reliability (αs > .70). No intervention was given before data collection, so RCT groups were combined for analysis. Pearson correlations were used to analyze relationships, and reported if significant at the p < .05 level. Results: Self-reported adherence was high (M = 2.4/3, SD = 1.0), with 50% of participants reporting perfect adherence over the past 3 days and another 25% reporting adherence on 2 of the past 3 days. Nonadherence correlated with negative mood (r = .59). More functional impairment, lower self-efficacy, lower treatment motivation, more side effects, and any nonprescribed drug use all correlated with barriers to adherence based on the Morisky scale (rs > .47). However, none of these were related to actual adherence behavior, with only motivation (r = .39, p = .06) and Morisky score (r = -.35, p = .10) approaching significance. All other direct effects of psychosocial factors on adherence behavior were small (rs < .27). Adherence was related to better health (r = .42) and marginally related to satisfaction with glaucoma medication (r = .37 p = .10). General health was associated with vision quality, fewer eye symptoms, and less functional impairment (rs > .50), but adherence was not. Implications: People with glaucoma have high but variable self-reported adherence, and adherence is related to better health and treatment satisfaction. Providers should monitor patients’ adherence and potential barriers. Adherence barriers and adherence behavior are distinct constructs, with barriers showing stronger relationships to psychosocial variables.en_GB
dc.subjectMedication adherenceen_GB
dc.subjectGlaucomaen_GB
dc.date.available2012-02-20T12:03:31Z-
dc.date.issued2012-02-20T12:03:31Z-
dc.date.accessioned2012-02-20T12:03:31Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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