title: Medication-related predictors of health-related quality of life in glaucoma patients enrolled in a medicare health maintenance organization.
abstract: BACKGROUND
  Glaucoma is an important public health concern in the United States, particularly among older adults (aged >or=65 years). Pharmacologic therapy for glaucoma consists mainly of topical eye drops containing beta-blockers or prostaglandin analogs.
  
  
  OBJECTIVE
  The goal of this study was to assess the associations between factors of topical medication use (self reported medication compliance, belief in benefit of medication use, usage difficulty, usage assistance, and complexity of medication regimen) and health-related quality of life (HRQOL) in a cross-sectional population of older patients with glaucoma.
  
  
  METHODS
  A self-administered, 48-question survey soliciting information on medication-taking behaviors, treatmen-trelated factors, and HRQOL was mailed to members of a Medicare health maintenance organization who were aged >or=65 years and had primary open-angle glaucoma. Two mailings were conducted 4 months apart; the second was sent to members whose responses to the first mailing had not yet been received. The 12-Item Short-Form Health Survey (SF-12) and the 25-Item National Eye Institute Visual Function Questionnaire (VFQ-25) were used to assess HRQOL. Other questions addressed perceptions of eye drop use in these patients. Multiple regression techniques were used to analyze associations between medication-related factors and HRQOL in this population.
  
  
  RESULTS
  The questionnaire was mailed to 589 patients; 375 responded (218 in the first mailing and 157 in the second mailing). A total of 358 responses were complete and analyzable (effective response rate, 62%). After controlling for the effects of other confounders, we found that self reported difficulty in using eye drops was strongly associated with decreased HRQOL (11.5% in VFQ-25 total score and 8.4% in SF-12 mental health score, P<0.05). Other medication-related factors that were examined were not significantly associated with changes in HRQOL.
  
  
  CONCLUSIONS
  Based on our findings, patients aged >or=65 years with glaucoma were likely to have significant comorbidity, which affected both visual and general health and well-being perception. Additionally, a significant proportion of these patients reported difficulty with use of topical medication, which was independently associated with a significant decrease in HRQOL. Care of older patients with glaucoma should incorporate strategies to minimize the difficulty associated with medication use.
authors.affiliation: Division of Management and Policy Sciences, University of Texas School of Public Health, Houston, Texas 77030, USA. Rajesh.Balkrishnan@uth.tmc.edu
authors.forename: Rajesh
authors.initials: R
authors.lastname: Balkrishnan
authors.forename: J Brent
authors.initials: JB
authors.lastname: Bond
authors.forename: Wesley G
authors.initials: WG
authors.lastname: Byerly
authors.forename: Fabian T
authors.initials: FT
authors.lastname: Camacho
authors.forename: Roger T
authors.initials: RT
authors.lastname: Anderson
mesh_terms: D000287:Administration, Topical; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D005901:Glaucoma / Q000188:drug therapy* / Q000523:psychology; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D009883:Ophthalmic Solutions; D010349:Patient Compliance; D011788:Quality of Life; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States
chemical_list: D009883:Ophthalmic Solutions