Adherence with topical glaucoma medication monitored electronically the Travatan Dosing Aid study.
ABSTRACT To assess patient adherence and behaviors with topical once-daily therapy for glaucoma.
Prospective, observational cohort study.
One hundred ninety-six patients with glaucoma who were being treated with a prostaglandin analog in 1 or both eyes at the Scheie or Wilmer Eye Institutes between August 2006 and June 2007.
Detailed medical history was obtained from each patient. All subjects used the Travatan Dosing Aid (DA; Alcon, Fort Worth, TX) to administer travoprost as prescribed. Devices were collected at 3 months and the data of drop usage was downloaded using software provided with the dosing aid. Data were analyzed for the 8-week period starting 2 weeks after the enrollment visit and ending 2 weeks before the 3-month visit.
Assessment of adherence and patterns of drop usage as indicated by the DA.
A total of 282 subjects consented to be in the study and 86 (30%) withdrew before study completion or had device errors, leaving 196 subjects (70%) with evaluable data at 3 months. The overall mean (+/-standard deviation) adherence rate was 0.71 (+/-0.24), ranging from 0.02 to 0.97. One hundred nine of these patients (55.6%) took greater than 75% of the expected doses. Those with adherence of less than 50% of expected doses showed substantially increased dose taking immediately after the office visit and just before the return visit at 3 months (P = 0.03). The mean adherence rate estimates of the physician and patient self-report were 0.77 and 0.95, respectively. The agreement between the physician assessment and DA-recorded adherence rate showed poor correlation for individual cases (intraclass correlation coefficient, 0.09; 95% confidence interval, 0.00-0.19).
Nearly 45% of patients using an electronic monitoring device who knew they were being monitored and were provided free medication used their drops less than 75% of the time. Patients reported far higher medication use than their actual behavior. The ability of the physician to identify which persons are poorly adherent from their self-report or from other subjective clues is poor.
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- SourceAvailable from: Maureen Price[show abstract] [hide abstract]
ABSTRACT: Patient adherence to warfarin may influence anticoagulation control; yet, adherence among warfarin users has not been rigorously studied. Our goal was to quantify warfarin adherence over time and to compare electronic medication event monitoring systems (MEMS) cap measurements with both self-report and clinician assessment of patient adherence. We performed a prospective cohort study of warfarin users at 3 Pennsylvania-based anticoagulation clinics and assessed pill-taking behaviors using MEMS caps, patient reports, and clinician assessments. Among 145 participants, the mean percent of days of nonadherence by MEMS was 21.8% (standard deviation+/-21.1%). Participants were about 6 times more likely to take too few pills than to take extra pills (18.8 vs. 3.3%). Adherence changed over time, initially worsening over the first 6 months of monitoring, which was followed by improvement beyond 6 months. Although clinicians were statistically better than chance at correctly labeling a participant's adherence (odds ratio = 2.05, p = 0.015), their estimates often did not correlate with MEMS-cap data; clinicians judged participants to be "adherent" at 82.8% of visits that were categorized as moderately nonadherent using MEMS-cap data (>or=20% nonadherence days). Similarly, at visits when participants were moderately nonadherent by MEMS, they self-reported perfect adherence 77.9% of the time. These results suggest that patients may benefit from adherence counseling even when they claim to be taking their warfarin or the clinician feels they are doing so, particularly several months into their course of therapy.Journal of General Internal Medicine 10/2007; 22(9):1254-9. · 3.28 Impact Factor
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ABSTRACT: To assess levels of compliance in elderly patients on timolol eyedrops for glaucoma. A postal questionnaire was sent from the general practitioner to 86 patients over 55 years of age on repeat prescriptions for timolol eyedrops. The questionnaire asked details about the duration of treatment, family history, the level of understanding of the disease and the importance of treatment, other regular medication, side-effects attributed to the drops and how often patients omitted their drops. A search of practice and local hospital dispensing data was carried out to assess how frequently monthly repeat prescriptions for timolol eyedrops were dispensed over a 12 month period. This allowed a total volume to be calculated for each patient. Twenty-four per cent of patients admitted to omitting eyedrops either occasionally or frequently. Fifty-one per cent were found to have had insufficient drops dispensed to comply with treatment as prescribed. In non-complaint patients the mean period without drops was 85 days of the year, with a maximum of 165 days. Compliance with treatment is poor and patients underestimate their level of defaulting when questioned.Eye 02/1998; 12 ( Pt 2):234-6. · 1.82 Impact Factor
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ABSTRACT: Electronic-monitored adherence is often used as the primary outcome measure for evaluating adherence interventions. However, electronic monitoring may not only measure adherence, but may also improve or impede adherence, making it difficult to assess the extent to which the observed effect size is attributed to the intervention versus electronic monitoring. This study examined whether electronic monitoring and patient diaries alter as well as measure adherence. A sample of 180 patients on highly active antiretroviral therapy (HAART) were randomized to one of three adherence surveillance methods (electronic monitoring caps, patient medication diaries, no surveillance control group) for 4 weeks, with adherence measured by a structured interview at baseline and study endpoint; 173 (96%) participants completed the study. After controlling for baseline adherence, a univariate analyses of adherence at study endpoint revealed no significant differences across groups, F(2, 169) = 0.32, p =.73, with mean adherence rates of 91.4, 92.4, and 93.8 for the electronic monitoring, diaries, and control group, respectively. Similarly, the proportion of participants with good adherence (> or = 95%) did not differ significantly from baseline to week 4 among all three subgroups. These results suggest that electronic monitoring caps and medication diaries do not alter adherence and can be used as outcome measures of interventions without the need to adjust the observed effect size.HIV Clinical Trials 01/2002; 3(1):45-51. · 2.30 Impact Factor