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- Initial medication adherence in newly diagnosed glaucoma patients: three adherence measuresPublication . Menino, Joana; Camacho, Pedro; Coelho, AndréAim: To determine initial medication adherence in newly diagnosed glaucoma patients treated with anti-glaucoma drugs. Methods: This retrospective and observational study included all patients diagnosed with glaucoma in the Primary Health Care units in Portugal during the years 2012 and 2013, which in consequence received a first prescription for anti-glaucoma drugs. Data were collected from electronic prescribing records of the primary care units and from pharmacy claims records. Initiation of glaucoma treatment and early discontinuation were measured, and the combination of (non)-initiation and early discontinuation accounted for the initial medication (non)-adherence. Results: A total of 3548 new glaucoma patients (40.1% male; 59.9% female) were included. 1133 (31.9%) patients were initially classified as non-users since there was no pharmacy claim found for their first prescription for glaucoma treatment. Additionally, 277 (11.5%) patients early discontinued their treatment, acquiring only their first prescription. Overall, the initial medication non-adherence rate was 39.7% since 1410 patients either didn't initiate treatment or discontinued it early. Conclusion: This study, reveals a major opportunity to improve glaucoma treatment and its control since a large proportion of patients fail to engage with their prescribed therapy, which implies that implementation of individual or group strategies that enable patients with glaucoma to correctly perform their treatment is still needed.
- Persistence with medical glaucoma therapy in newly diagnosed patientsPublication . Menino, Joana; Camacho, Pedro; Coelho, AndréBackground: Monotherapy, age, and side effects are significant risk factors for the discontinuation of antiglaucoma therapy. Long-term therapy persistence is crucial for slowing disease progression and preventing irreversible blindness. Therefore, it is essential to identify patients at higher risk of discontinuation. In this study, we aimed to evaluate the real-world persistence of antiglaucoma therapy in patients diagnosed with glaucoma in the primary healthcare units of the Lisbon and Tagus Valley regions. Methods: We conducted a retrospective longitudinal study by collecting data from the prescription records of new antiglaucoma drug users diagnosed with glaucoma between 2012 and 2013 in the Primary Health Care Units of the Lisbon and Tagus Valley Region. These patients were followed over 3 years. Therapy persistence was measured as the proportion of patients remaining on any antiglaucoma drug, regardless of any modifications or switching of drugs over time. Persistence was assessed at three time points: the end of the first, second, and third years of the observation period. Results: A total of 2138 patients treated using new antiglaucoma drugs (867 [40.6%] male patients; 1271 [59.4%] female patients) were included in the study. Over the observation period, the overall persistence rate decreased from 91.9% (n = 1965) in the first year to 67.3% (n = 1439) in the third year. Older patients (≥ 65 years) showed higher persistence rates, although there was a decrease over the 3-year follow-up period (from 1481 [92.7%] to 1124 [70.4%]). Additionally, participants initially treated with monotherapy showed higher persistence rates, ranging from 92.4% (n = 1186) in the first year to 70.2% (n = 901) in the third year. Conclusions: The findings highlight the importance of patient follow-up over time, as almost one in three new antiglaucoma therapy users completely discontinued treatment, potentially risking disease progression. This could be mitigated with proper use of these drugs. Further studies should utilize recent health information systems to explore the impact of medication adherence and persistence on the functional and structural outcomes in patients with glaucoma.
- Avaliação da adesão à terapêutica em doentes com diabetes tipo 2 e hipertensão arterial: adesão à medicação nas doenças crónicasPublication . Rosu, Amalia; Coelho, André; Camacho, PedroObjetivos: Avaliação da adesão à terapêutica em doentes recém-diagnosticados com Diabetes Mellitus tipo 2 e Hipertensão Arterial, nos Cuidados de Saúde Primários na Região Lisboa Vale Tejo. Metodologia: Estudo observacional de coorte retrospetivo. População composta pelos doentes recém-diagnosticados com Diabetes Mellitus tipo 2 e Hipertensão Arterial, em início de tratamento. Os dados foram extraídos do Sistema de Informação da Administração Regional de Saúde de Lisboa Vale Tejo. A adesão à terapêutica foi avaliada nas suas três componentes: se os doentes iniciaram a terapêutica prescrita (iniciação); através do Medication Possession Ratio (MPR) durante o período de seguimento (implementação) e a descontinuação da medicação, que marca o fim do tratamento (descontinuação). Resultados: A taxa de iniciação foi de 84.2% nos doentes com ambas as doenças (98% para a terapêutica antidiabética oral e 84.6% para a terapêutica anti-hipertensiva). A taxa de implementação (MPR) para ambas as doenças foi de, apenas 3.4% (4.2% foram considerados aderentes com a terapêutica antidiabética oral e 8.5% para a terapêutica anti-hipertensiva). A taxa de descontinuação foi de 3.4% (5.5% para a terapêutica antidiabética oral e 13.2% para terapêutica anti-hipertensiva). A maioria dos doentes iniciam a toma da medicação após a prescrição, mas poucos têm uma implementação suficiente para que a adesão seja considerada boa. Poucos doentes descontinuaram a medicação. Conclusão: Os doentes tiveram uma maior taxa de implementação à terapêutica anti-hipertensiva, mas, por outro lado, foram mais persistentes à terapêutica antidiabética oral. O padrão da adesão à terapêutica parece ser influenciado pelo doente e pela própria doença.