Detection Of Noncompliance

There is no gold-standard technique for detecting poor compliance; thus, in the day-to-day office practice of glaucoma, detection of noncompliance is exceedingly difficult. Methods used to detect noncompliance in clinical studies, such as electronic medication monitors, pill counts, and blood tests for drug or metabolite levels,10,13,55-57 are expensive and may not be applicable to ophthalmic medications. Physicians are usually unable to accurately gauge the level of compliance in their own patients, even those who have been under their care for years.3,10,55,58 The value of asking a patient about compliance is relatively low because most patients will tell their doctor ''what the doctor wants to hear'' instead of accurately reporting their adherence.3,7,10,15,56,57,59-61 If a patient admits to poor compliance, he or she is likely to be telling the truth. Questionnaires have been developed to determine compliance with medical regimens.62 It is possible that these will be useful in glaucoma management, but further research is required to prove their value (table 14.3).

Table 14.3 Self-Reported Medication-Taking Scale: A Four-Item Questionnaire

1. Do you ever forget to take your medicine?

2. Are you careless at times about taking your medicine?

3. When you feel better, do you sometimes stop taking your medicine?

4. Sometimes if you feel worse when you take the medicine, do you stop taking it?

Source: Modified with permission from Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24:67-74.

It is often recommended that patients bring their eye drop bottles to each office visit. This is an indirect measure of adherence but may be useful in detecting gross noncompliance. In some medical systems, it may be possible to monitor the frequency of prescription refills, which, again, is an indirect measure of adherence but does provide information to the physician.

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