A clinician's guide to the assessment and management of nonadherence in glaucoma.
OBJECTIVE
To apply lessons learned in the treatment of systemic hypertension to the problem of nonadherence in glaucoma medical therapy.


CONCLUSIONS
Although physicians recognize that nonadherence with glaucoma medication is a problem, most lack the skill set to identify nonadherent patients, to identify the causes of nonadherence, and to provide solutions to address nonadherence.


METHODS
A PubMed search was conducted using the terms "adherence" OR "compliance" AND "hypertension," with the following limitations: title, English language, humans, from 2000 through 2009. Other studies identified outside of the PubMed search were included if relevant.


RESULTS
Studies from the systemic hypertension literature suggest that simplifying medication regimens, lowering costs, and patient education about the disease and the importance of taking medications are successful strategies for improving adherence. In addition, good family or social support, frequent physician visits, and pairing medication administration with specific activities (such as meals or brushing one's teeth) can help improve adherence.


CONCLUSIONS
The body of literature on adherence interventions in chronic diseases such as systemic hypertension shows that although many interventions have been tested and evaluated, only some are successful. Paradigms derived from behavioral medicine and nursing offer valuable lessons on how to motivate patients to change behavior, but these activities require skill sets not traditionally taught in medical school. Just as there are myriad causes of nonadherence, the interventions most likely will need to be multifaceted and tailored to the individual patient.


BACKGROUND
Proprietary or commercial disclosure may be found after the references.
Budenz
Donald L
DL
Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Florida 33136, USA. dbudenz@med.miami.edu
D000488:Allied Health Personnel / Q000523:psychology; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001766:Blindness / Q000517:prevention & control; D005901:Glaucoma / Q000188:drug therapy*; D015438:Health Behavior; D006801:Humans; D009042:Motivation; D009883:Ophthalmic Solutions / Q000008:administration & dosage*; D010349:Patient Compliance / Q000523:psychology*; D010353:Patient Education as Topic; D010817:Physician-Patient Relations
D000959:Antihypertensive Agents; D009883:Ophthalmic Solutions