An assessment of readiness for behaviour change in patients prescribed ocular hypotensive therapy

Objectives: To compare responses in two patient populations with a questionnaire developed to identify those prescribed ocular hypotensive medication whose adherence may need improvement and who may be ready to change. Methods: The content/face validity of a 62-item, self-administered questionnaire was confirmed by nine glaucoma specialists. Questions concerned demographics, health and medications, use of/problems with medications, and visual function. The questionnaire was administered anonymously to 102 consecutive patients in a glaucoma referral practice ('glaucoma practice') and 100 from a multispecialty ophthalmology practice ('multispecialty practice'). All participants were prescribed ≥1 ocular hypotensive medication and had no previous trabeculectomy. Results: Patients in the glaucoma practice were more likely to be younger, African-American, and better educated (P<0.05 for each). In both, >80% had glaucoma with >60% diagnosed ≥3 years previously. Most (glaucoma, multispecialty: 87, 93%) reported administering drops every day, but more in the multispecialty practice reported administering drops at the same time every day (79, 92%; P<0.05). Number of adherence problems (mean, 1/patient) and adherence scores (mean, 24; possible scale range, 0-25) were similar. Common adherence barriers were falling asleep and forgetting when the regular schedule changed or when travelling. In the glaucoma practice, the number of adherence problems was correlated with adherence score (r=-0.611; P<0.0001) and number of side effects (r=0.349; P<0.0001). Conclusions: Similarities between patient populations limited our ability to compare responses between groups or to propose adherence counselling tailored to specific demographics. Until such recommendations are possible, physicians should incorporate adherence counselling broadly into their practices.