title: Factors associated with adherence to glaucoma pharmacotherapy in the primary care setting.
abstract: BACKGROUND
  Primary open-angle glaucoma is a leading cause of irreversible blindness.
  
  
  OBJECTIVE
  To identify factors associated with adherence to glaucoma pharmacotherapy in the primary care setting, focusing on physicians' role.
  
  
  METHODS
  Patients were recruited from primary care clinics and telephone-interviewed using a structured questionnaire that addressed patient-, medication-, environment- and physicians-related factors. Patients' data on pharmacy claims were retrieved to calculate the medication possession ratio for measuring adherence.
  
  
  RESULTS
  Seven hundred thirty-eight glaucoma patients were interviewed. The multivariate analysis identified eight variables that were associated independently with adherence. Barriers to adherence were found to be low income, believing that 'It makes no difference to my vision whether I take the drops or not' and relying on someone else for drop instillation (exp(B) = 1.91, P = 0.002; exp(B) = 2.61, P < 0.0001; exp(B) = 2.17, P = 0.001, respectively). Older age, having a glaucoma patient among close acquaintances, taking a higher number of drops per day, taking a prostaglandin drug and reporting that the ophthalmologist had discussed the importance of taking eye drops as prescribed, were found to promote adherence (exp(B) = 0.96, P < 0.0001; exp(B) = 0.54, P = 0.014; exp(B) = 0.81, P = 0.001; exp(B) = 0.37, P < 0.0001; exp(B) = 0.60, P = 0.034, respectively). No association was found between the patient's relationship with the family physician and adherence to glaucoma treatment.
  
  
  CONCLUSIONS
  Adherence to glaucoma pharmacotherapy is associated with patient-related, medication-related, physician-related and environmental factors. Ophthalmologists have a significant role in promoting adherence. However, the potential role of family physicians is unfulfilled and unrecognized.
authors.affiliation: Division of Family Medicine, Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, hforitco@gmail.com.
authors.forename: Orit
authors.initials: O
authors.lastname: Cohen Castel
authors.affiliation: Faculty of Social Welfare and Health Sciences, School of Public Health, University of Haifa, Haifa.
authors.forename: Lital
authors.initials: L
authors.lastname: Keinan-Boker
authors.affiliation: Department of Ophthalmology, Carmel Medical Center, Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa and.
authors.forename: Orna
authors.initials: O
authors.lastname: Geyer
authors.affiliation: Division of Family Medicine, Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Department of Family Medicine and Clinical Research Unit, Clalit Health Services, Haifa and Western Galilee District, Haifa, Israel.
authors.forename: Uzi
authors.initials: U
authors.lastname: Milman
authors.affiliation: Division of Family Medicine, Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Department of Family Medicine and.
authors.forename: Khaled
authors.initials: K
authors.lastname: Karkabi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D005260:Female; D005901:Glaucoma / Q000188:drug therapy*; D006801:Humans; D007557:Israel; D008297:Male; D055118:Medication Adherence; D009885:Ophthalmology; D010819:Physician's Role; D010821:Physicians, Family; D011320:Primary Health Care; D011795:Surveys and Questionnaires
chemical_list: D000959:Antihypertensive Agents
keywords: Doctor–patient relationship; family physicians; glaucoma; patient adherence; primary care.