title: Glaucoma patient expression of medication problems and nonadherence.
abstract: OBJECTIVE
  The purpose of this study was to examine if patient demographic factors influenced self-reporting of medication side effects, difficulty with drop instillation, and nonadherence to glaucoma therapy.
  
  
  METHODS
  English-speaking adult glaucoma patients (n = 279) from six ophthalmology clinics were enrolled. Patients' medical visits were videotaped and patients were interviewed immediately afterward by research assistants. The videotapes were transcribed verbatim and coded to identify patients who expressed problems with medication side effects, eye drop administration, and nonadherence during the glaucoma office visits. Generalized estimating equations were performed to identify whether patient characteristics were associated with expression of problems with glaucoma medication and medication nonadherence during the office visit.
  
  
  RESULTS
  Patients with lower health literacy were significantly less likely to express problems with side effects (odds ratio [OR], 0.47; 95% confidence interval [CI], 0.25 to 0.88) and eye drop administration (OR, 0.26; 95% CI, 0.11 to 0.63) during the visit. Patients who reported eye drop administration and side effect problems during the interview were significantly more likely to express these problems to their ophthalmologist (OR, 3.13; 95% CI, 1.82 to 5.37 and OR, 1.86; 95% CI, 1.12 to 3.08, respectively). Patients who expressed a problem with eye drop administration and with side effects were significantly more likely to express medication nonadherence to their ophthalmologist (OR, 2.89; 95% CI, 1.44 to 5.80 and OR, 2.03; 95% CI, 1.16 to 3.54, respectively). Patients who reported greater than 80% medication adherence during the interview were significantly less likely to express nonadherence to their ophthalmologist (OR, 0.22; 95% CI, 0.12 to 0.40).
  
  
  CONCLUSIONS
  Eye care providers should be aware that glaucoma patients with lower health literacy are less likely to express problems with side effects and eye drop administration. Providers should work with patients to assess medication-related problems to mitigate potential barriers to medication adherence because patients who expressed medication problems were also more likely to express nonadherence.
authors: *PhD †PharmD ‡BA §PhD, MSPH ∥MD Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (CS, RS, MV, DMC, SJB, BS); Department of Ophthalmology, University of Maryland, Baltimore, Maryland (ALR); Department of Ophthalmology University of Michigan, Ann Arbor, Michigan (ALR); Department of International Health, Bloomberg School of Public Health, Baltimore, Maryland (ALR); Department of Ophthalmology, School of Medicine, Johns Hopkins University, Baltimore, Maryland (ALR); Department of Ophthalmology, School of Medicine, Duke University, Durham, North Carolina (KWM); Durham VA Medical Center, Health Services Research and Development, Durham, North Carolina (KWM); Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center University of Utah, Salt Lake City, Utah (MEH); and Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (BS).
authors: Catherine
authors: C
authors: Slota
authors: Robyn
authors: R
authors: Sayner
authors: Michelle
authors: M
authors: Vitko
authors: Delesha M
authors: DM
authors: Carpenter
authors: Susan J
authors: SJ
authors: Blalock
authors: Alan L
authors: AL
authors: Robin
authors: Kelly W
authors: KW
authors: Muir
authors: Mary Elizabeth
authors: ME
authors: Hartnett
authors: Betsy
authors: B
authors: Sleath
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D005901:Glaucoma / Q000188:drug therapy* / Q000208:ethnology; D057220:Health Literacy / Q000706:statistics & numerical data*; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions / Q000008:administration & dosage / Q000009:adverse effects; D010361:Patients / Q000523:psychology*; D011795:Surveys and Questionnaires; D044465:White People; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D000959:Antihypertensive Agents; D009883:Ophthalmic Solutions