|Combigan 0.2%/0.5% from Allergan is available
in a 15ml bottle, providing patients with a 90-day
supply and fewer trips to the pharmacy.
How to encourage your patients with glaucoma to be adherent and compliant.
Lack of adherence and compliance with medications in general is an issue””and caring for glaucoma is no exception. Although often used interchangeably, adherence implies filling a new or refilling an existing prescription, while compliance means taking the medication as prescribed. Often, non-compliance stems from poor patient education/doctor communication. Although we can blame many factors, including the cost of medication, the complexity of multiple meds or dosing schedules, adverse events, physical and lifestyle barriers, and memory issues, among others, our responsibility is to assure that our patients can access their prescriptions and successfully maintain compliance for the best medical outcomes.
Compliance starts with educating our patients on what glaucoma is and the potential for blindness as a result of non-compliance. Emphasizing blindness is accurate and sends a clear message about the importance of following your directives. When dealing with an asymptomatic disease, it is often difficult for patients to appreciate the consequences of non-compliance. The more educated patients are about their disease and the potential risks of non-compliance, the better chance you have of their adhering to a specific treatment regimen. I spend a significant amount of time educating my glaucoma patients prior to initiating treatment. I discuss the best-case scenario of one medication to the worst-case scenario of invasive surgery.
MAKE COMPLIANCE EASIER
Patients tend to view topical drugs as less important than oral drugs. Review drop instillation to assure that patients can actually put their drops in properly. Try to limit the number of bottles they have to use by prescribing combination drugs when indicated vs. multiple individual drugs. (For instance, prescribe Combigan from Allergan instead of Alphagan P from Allergan and Timolol Maleate Ophthalmic Solution from Akorn Ophthalmics.) If that’s not an option, I have my patients number (for example, 1, 2 and 3) the bottom of each bottle so they don’t confuse which drop they instill first and so on. Most people don’t forget to brush their teeth, so I suggest placing their drops next to their toothbrush, especially since most glaucoma drops are dosed once or twice daily.
Based on a patient’s insurance coverage and financial situation, I often need to prescribe generic drugs. Remember, the best glaucoma drug is the one they can afford. Researchers at the University of Michigan studied medication adherence rates 18 months before and after the first generic PGA (latanoprost) became available in March 2011. Their results demonstrated improved compliance when co-pays were lower, compared to a 39% decline in adherence for those who remained on a brand-named drug.
I am blunt when questioning a patient’s compliance on follow-up visits, so I don’t change my course of therapy based on false information. You can review the number of refills used vs. the time frame since their last visit. Or consider alternative, non-medical treatment options such as selective laser trabeculoplasty or microinvasive glaucoma surgery to reduce or eliminate the need for topical drops. This can often be very effective and limit the patient’s monthly pharmacy expense.
Our burden is great in assuring that our patients understand that although glaucoma starts out as a painless, asymptomatic disease, the risk of vision loss is significant and irreversible. I explain that my role is to be sure that they never lose their ability to drive or read due to glaucomatous visual field loss””a statement that resonates with most.
Glenn S. Corbin, OD, is partner/president of Wyomissing Optometric Center in Reading, PA.