Medication Compliance in Glaucoma.

The work is to be 8 pages with three to five sources, with in-text citations and a reference page. Glaucoma is an important global public health concern with the proportion of patients burdened with this sight-threatening disease ever increasing due to the rapidly aging population. In Australia, glaucoma causes 3% visual impairment and 14% blindness in patients aged 40 and over. Since the majority of glaucoma patients are managed initially with medical therapy, compliance is critical for decreasing disease progression. Despite the availability of effective pharmacologic therapies, non-compliance in patients with glaucoma has been reported to vary from 24 to 59%. Many obstacles affect treatment compliance including regimen factors (refill, cost, complexity, change, side effects), patient factors (knowledge, skill, memory, motivation, health beliefs, comorbidities), provider factors (dissatisfaction, communication) and situational or environmental factors (lack of support, major life events, travel, competing activities, change in routine). Quality of written instructions such as the amount of information and readability is important in ensuring medication compliance especially in visually impaired, elderly patients where written treatment information often supplements verbal instruction. In some cases, especially when a patient has a caregiver, this information becomes the main source reference for correct interpretation of their medication regime. The aim of our study was to assess whether readability and comprehension of medication label size was a contributing factor to treatment compliance in glaucoma patients.

Materials and methods

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Eighty subjects with diagnosed glaucoma were recruited from the public out-patient clinic of a tertiary eye hospital in Melbourne, Australia. The duration of the study was 6 weeks (27.03.07 to 8.5.07). The selection of participants was random. They participated in a survey which included basic demographic data such as age and gender. Subjects were asked to recall the name, quantity, instructions, and compliance of prescribed topical drops for glaucoma. Information was collected regarding visual acuity, refraction, intraocular pressure, visual field tests and optic cup to disc ratio, to assess the severity of their glaucoma. This study was designed as a cross-sectional patient survey and concomitant chart review. Written informed consent was obtained for survey participation and review of the medical records. Inclusion criteria included a diagnosis of primary or secondary glaucoma and visual field tests. Subjects who did not speak English or required an interpreter for understanding English were excluded from the study. Chart information from the preliminary Orthoptic assessment was initially reviewed to ensure that the inclusion criteria were met. Also, details about the current use of eye drops, presence of correction spectacles for reading and absence of dilatation were taken into account. The medical records were reviewed for results of visual acuity, refraction, intraocular pressure, visual field tests and optic cup to disc ratio. Near vision was assessed under standard room lighting using the near-point Snellen acuity card held at usual reading distance, with the subjects wearing their usual reading glasses if indicated. The visual field was graded according to the Glaucoma Staging System (GSS).

Two trained interviewers administered the questionnaire to participants in a single interview room one at a time. Participants were then asked if they could recall the name and instructions for their own current eye medications. The accuracy of self-reporting was checked against the review of the patient’s own medical history. Finally, participants were presented with four sample labels and asked the same three questions on each label.

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