title: The Maccabi Glaucoma Study: Treatment Patterns and Persistence With Glaucoma Therapy in a Large Israeli Health Maintenance Organization.
abstract: OBJECTIVE
  To describe treatment patterns, adherence, and persistence with initial therapy among glaucoma patients in the community.
  
  
  METHODS
  A population-based historical prospective cohort study, using the electronic medical databases of Maccabi Healthcare Services, a 2 million member health maintenance organization in Israel. Newly diagnosed glaucoma patients between 2003 and 2010, who purchased at least 1 antiglaucoma medication, were followed up to December 31, 2012. Outcome measures included medication adherence analyzed by proportion of days covered by drugs during follow-up time, and persistence with initial therapy measured by time until switch or discontinuation of first-line therapy.
  
  
  RESULTS
  A total of 5934 incident definite glaucoma patients were identified, 13% of whom were nonadherent with therapy (covered <20% of the follow-up time), and only 25% exhibited high adherence (covered at least 80% of the follow-up period). Adherence was positively associated with female sex, age, socioeconomic status, frequent follow-up visits, and higher baseline intraocular pressure. Lower median adherence (P<0.01) was observed among patients of normal tension glaucoma (52%) and angle closure (59%) as compared with open angle (65%) and exfoliation glaucoma (68%). Patients treated by glaucoma specialists had similar adherence to those treated by general ophthalmologists (proportion of days covered=65% vs. 63%, P=0.42). Persistence with initial line of therapy varied by type of medication, with prostaglandin initiators exhibiting the highest persistence (13% reduced likelihood of switch or discontinuation as compared with β-blockers, P<0.01) and α-agonists the lowest persistence (39% increased likelihood of switch or discontinuation as compared with β-blockers, P<0.01).
  
  
  CONCLUSIONS
  This large-scale analysis of real-world use of glaucoma medications reveals that adherence to glaucoma therapy is associated with medication type, patient's sex, age, socioeconomic status, type of glaucoma, follow-up visits, and baseline intraocular pressure.
authors.affiliation: *Medical Division, Maccabi Healthcare Services †Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv ‡Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: Inbal
authors.initials: I
authors.lastname: Goldshtein
authors.forename: Varda
authors.initials: V
authors.lastname: Shalev
authors.forename: Nir
authors.initials: N
authors.lastname: Zigman
authors.forename: Gabriel
authors.initials: G
authors.lastname: Chodick
authors.forename: Hani
authors.initials: H
authors.lastname: Levkovitch-Verbin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005901:Glaucoma / Q000188:drug therapy*; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data*; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects*; D007557:Israel; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016903:Drug Monitoring
chemical_list: D000959:Antihypertensive Agents