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Guest Editor
Compliance Matters
By
Eve J Higginbotham MD
WHEN it comes to a successful medical regimen, compliance is critical.
Yet patient compliance is one of the most difficult challenges for
both physician and patient.
The issue is as old as the field of medicine itself because it is
one thing to prescribe a medical regimen and quite another for a
patient to adhere to the prescribed regimen.
The issue is particularly problematic in glaucoma, where the importance
of daily compliance to the treatment runs up against considerable
inconvenience to the patient. Given those challenges, the development
of drugs which do not require frequent instillation and have few
side-effects is a priority.
There are several studies in the literature which relate to the
issue of compliance. Most notably are the studies done by Michael
Kass MD and co-workers1 in compliance with topical
anti-glaucoma medications was evaluated.
Dr Kass studied timolol b.i.d and pilocarpine q.i.d using a device
which objectively measured the number of times the bottled medication
was actually instilled by the patient over a period of time.
Forty-five patients used both medications concurrently. The investigators
reported that compliance with timolol was greater (used bid) at
84.3% +/- 14% compared with pilocarpine (instilled qid) at 77.7%
+/-18.7%.
Outside the field of ophthalmology, compliance has been studied
in diseases such as epilepsy, a disorder which has significant social
and health ramifications if the patient does not remain compliant
with the regimen.
It is reasonable to assume, therefore, that compliance should be
close to 100%. But even considering the consequences of non-compliance
with epilepsy, researchers found the rate of compliance was as low
as 39% when the medical regimen required that the drug be taken
q.i.d compared to 87% when it was prescribed once daily.2
So considering these levels of non-compliance with a drug regimen
that carries significant social ramifications, the challenges facing
physicians who care for glaucoma patients, most of whom have not
yet experienced significant adverse functional impact from their
disease, are particularly difficult to counteract.
These studies underline that frequency of administration is very
important in patient compliance. In ophthalmology, we have yet another
hurdle to overcome — the spacing of instillation when multiple
bottles are used. We often have to remind our patients that they
need to wait at least five minutes between drops.
The development of fixed combination regimens represents important
progress on this front. The likelihood that patients will comply
increases in proportion to the simplicity of the regimen. A combination
drop such as Xalacom avoids some of these issues. A single drop
aids compliance and two different medications in the same drop is
both convenient and perhaps more effective.
Compliance will always remain an issue both physicians and patients
will need to consider when any medical regimen is prescribed. It
is hard enough managing a single medicine a day. When multiple medications
are prescribed and multiple bottles are necessary to adhere to such
a regimen, then the regimen becomes more complex.
Clinicians can further improve patient compliance by regularly ensuring
that patients understand the regimen prescribed for them, and its
importance in slowing their vision loss. The better we are at this
task, the better our patients will do.
1
Kass MA, Gordon M, Morley RE, et al.
Compliance with topical timolol treatment.
1987 American Journal of Ophthalmology. 1987; 103:188-193.
2 Cramer JA, Mattson RH, Prevey ML, et al.
How often is medication taken as prescribed?
A novel assessment technique. 1989; 261:3273-3278.
Eve
J Higginbotham MD
Professor and Chair, Department of Ophthalmology,
University of Maryland School of Medicine
Baltimore, US
Email: fcwejh6786@aol.com
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