Report from the WGA Committee on Cooperation with Medical Therapy
Harry Quigley (co-chair), Ivan Goldberg, Yoshi Kitazawa, Rick Halprin, Roger Hitchings (co-chair), Ron Gross, Pat Taylor, Marko Michaskiw, Mark Ypinga, David Friedman, Lou Cantor, Steve Obstbaum and John Walt
Glaucoma is a highly prevalent, asymptomatic disease that is often treated with the prescription of chronic eyedrop therapy. As with other chronic medical conditions, the cooperation of patients with prescribed medical regimens is less than ideal. This committee will evaluate issues related to the effectiveness of therapy and its improvement, using both glaucoma-specific and general medical information. Those issues that seem immediately relevant to explaining poor patient cooperation with therapy, include (among others): lack of symptoms, slow progressive change in visual function, delay in loss of quality of life until late in the disease, poor patient understanding of the disorder, lack of adequate physician educational efforts, cost of medication, frequent dosage, and multi-drug regimens
The WGA Committee on Medical Therapy will seek to improve the efficacy of glaucoma therapy by study of the issues leading to imperfect drug taking among glaucoma patients.
Phase 1: Organization
- Define the committee mission and objectives.
- Define work required to achieve objectives.
- Determine criteria for committee participation (one or more):
- Knowledge of or prior research into effectiveness of glaucoma medical therapy;
- International geographic representation;
- Industry partners;
- Public policy partners;
- Patient advocates.
- Determine an interactive methodology (e-mail, personal meetings).
- Determine a time line for the project.
- Generate a document describing the committee’s aims and methods.
Phase 2: Data collection
- Assess literature on patient cooperation with therapy for glaucoma.
- Assess literature in general medical diseases that are similar to glaucoma.
- Define poor patient cooperation with therapy.
- Research available data sources for additional information on cooperation.
- Identify risk factors for poor patient cooperation with therapy.
- Identify areas of knowledge needed to assess the issue for glaucoma.
- Identify possible actions that would improve cooperation with therapy:
- Improved Physician-Patient communication;
- Barriers to patient cooperation (side effects, ignorance, personality);
- Role of family history of glaucoma (enlisting family advocates);
- Healthcare system barriers (cost, reimbursement);
- Physician knowledge of problem;
- Gender issues;
- Ethnicity issues;
- Means of measuring cooperation (outcome devices).
- Generate a document summarizing definitions, literature review, risk factors, and potential actions to study the questions of interest.
Phase 3: Recommendations
- Develop intervention recommendations to improve cooperation.
- Identify populations for study.
- Identify study designs to influence cooperation:
- Behavioral intervention, including devices, processes, incentives or packaging designed to remove patient barriers in obtaining and taking the medication;
- Educational interventions, including information on patient condition, treatment and medication delivered verbally, electronically or in hard copy by physicians, educators, support groups, and/or family members;
- Media campaigns, including email, pamphlet, newspaper, or magazine;
- Case management interventions, including therapy plans customized to patient need, medical condition, managed by a healthcare professional, and including literature, telephone reminders, and mailings.
- Generate a document describing the committee’s suggestions for possible research studies into interventions to improve cooperation with glaucoma therapy.
Phase 4: Motivating investigations into improved cooperation with therapy
- Develop plans to motivate international research into the areas of study that are likely to improve knowledge in patient cooperation.
- Define the role of WGA committee member organizations.
- Identify methods to fund studies of cooperation.
- Increase awareness of cooperation issues with ophthalmologists.
- Develop a document describing the committee’s plan for recommended interventions.
Compliance: Use of medication in accordance with prescribed regimen.
Persistence: Continuous use of a prescribed medication with no lapses. This is the most stringent definition. There is building use of a less stringent terminology in which some more latitude is allowed in refill lapse before calling the patient non-persistent. However, this would be arbitrary and dependent upon assumptions of how long it takes to use up certain volumes of eyedrops.
Adherence: Continued use of a prescribed medication at any time point after initial prescription. In essence, this is a very relaxed version of persistence, for which a patient could lapse for a considerable period (months), but still be ‘adhering’ if a refill of eyedrops occurred at some later time.
The committee notes that overuse of medication, as a form of failure to follow instruction, is not taken into account in these definitions, and in studies one may need a word for this behavior.
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