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Compliance Barriers in Glaucoma: A Systematic Classification

Tsai, James C. MD, MBA*†; McClure, Cori A. BA; Ramos, Sarah E. BA; Schlundt, David G. PhD‡§; Pichert, James W. PhD

Original Articles

Purpose To systematically identify and describe common obstacles to medication adherence (i.e., compliance) for patients with glaucoma.

Methods A prospective case series of structured interviews were conducted with 48 patients with glaucoma. The subjects' responses were recorded verbatim on interview forms as well as recorded on audiotapes. Situational obstacles to medication adherence were elicited. Using hierarchical cluster analysis, the situational descriptions were stratified, grouped, and analyzed by frequency distribution.

Results Seventy-one unique situational obstacles were reported. These were then grouped into 4 defined and separate categories: situational/environmental factors (35 of 71 situations; 49%), medication regimen (23 of 71; 32%), patient factors (11 of 71; 16%), and provider factors (2 of 71; 3%).

Conclusion Significant barriers to compliance exist for patients with glaucoma in addition to those cited by previous ophthalmic studies. A systematic classification (i.e., taxonomy) of these barriers was formulated to assist in optimizing patient education and problem-solving regarding prescribed therapeutic regimens.

*Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, New York; †Departments of Ophthalmology, ‡Medicine, and §Psychiatry, Vanderbilt University School of Medicine, Nashville, Tennessee

Received February 27, 2003; accepted April 30, 2003.

Presented in part at the Association for Research in Vision and Ophthalmology, Fort Lauderdale, Florida, May 2002.

Supported in part by the Homer McK. Rees Scholar Award (J.C.T.), Eye Surgery Fund (J.C.T.), Siegal Research Fund (J.C.T.), NIH Short Term Research Training Grant T35KDK07373 (C.A.M. and S.E.R.), and an unrestricted grant from Research to Prevent Blindness, New York, New York.

Address correspondence and reprint requests to James C. Tsai, MD, MBA, Harkness Eye Institute, 635 West 165th Street, New York, NY 10032. E-mail:

© 2003 Lippincott Williams & Wilkins, Inc.