Comparison of Medication Adherence Assessment Tools to Identify Glaucoma Medication Nonadherence

Area of Science:

• Ophthalmology
• Pharmacology
• Health Services Research

Background:

• Medication adherence is crucial for effective glaucoma management.
• Accurate assessment of adherence is challenging in clinical practice.
• Electronic monitoring provides objective adherence data but is resource-intensive.

Purpose of the Study:

• To evaluate the accuracy of subjective self-assessment tools and pharmacy refill data in predicting objective electronic monitoring of glaucoma medication adherence.
• To identify the most effective tool for predicting nonadherence among glaucoma patients with initially poor self-reported adherence.

Main Methods:

• A prospective cohort study involving glaucoma patients (>40 years old) with self-reported poor adherence.
• Comparison of 5 subjective tools (3 adherence measures, 2 psychometric scales) and pharmacy refill data against 3-month electronic monitoring (AdhereTech).
• Analysis using correlation coefficients and receiver operating characteristic (ROC) curves to assess predictive accuracy.

Main Results:

• Pharmacy refill data showed no significant correlation with electronic monitoring (r=0.12).
• A single-item adherence question demonstrated the strongest correlation (r=0.47) and highest accuracy (71%) in predicting nonadherence.
• This question achieved an area under the curve (AUC) of 0.76 and sensitivity of 84% for identifying nonadherent patients.

Conclusions:

• A single-item adherence question is the most accurate and practical tool for predicting electronically monitored nonadherence in glaucoma patients with poor self-reported adherence.
• This free screening question offers a resource-efficient method for identifying at-risk patients in clinical settings.
• The findings support the use of this simple question to guide interventions for improving medication adherence.