PATIENT NONCOMPLIANCE IN THE MANAGED CARE SETTING - THE CASE OF MEDICAL THERAPY FOR GLAUCOMA

OBJECTIVES. The authors identify demographic and clinical characterist ics associated with noncompliance in patients beginning medical therap y for the treatment of glaucoma in a managed care setting. METHODS. Th e authors describe a retrospective cohort study in a group-model healt h maintenance organization in Massachusetts. Patients were members of the health maintenance organization who were newly initiated on topica l drug therapy to treat open-angle glaucoma during the period January 1, 1987 through December 31, 1990, who met eligibility requirements, a nd who had evidence of health services utilization for a 12-month foll ow-up period. For all study subjects, we determined the number of days without available therapy for glaucoma during the 12-month period. St udy subjects who did not fill prescriptions adequate to provide medica tion to cover at least 80% of days during the study period were consid ered noncompliant. Logistic regression analysis was used to assess dem ographic and clinical factors independently associated with noncomplia nce among patients initiated on medical therapy for the treatment of g laucoma. RESULTS. Of 616 subjects who met inclusion criteria, 152 (24. 7%; 95% confidence interval, 21.3%-28.1%) met the study definition for noncompliance. These patients had an average number of days without t herapy during the 12-month study period of 103.9 +/- 70.0 days compare d with 6.8 +/- 19.5 days for those categorized as compliant. Of a vari ety of selected demographic and clinical characteristics, having fewer visits with an ophthalmologist during the study period (<2) was most strongly related to noncompliance (odds ratio 2.99; 95% confidence int erval 2.03, 4.40). There were no differences in average intraocular pr essure between the compliant and noncompliant groups during the study period. CONCLUSIONS. Noncompliance with prescribed medical therapy for glaucoma was found to be common in a managed care setting characteriz ed by essentially unrestricted access to health care and medications. It remains difficult to identify noncompliant patients based on demogr aphic and clinical characteristics. The use of automated prescription data to identify noncompliant patients is feasible in large managed he alth care insurance programs where such data are collected routinely f or administrative purposes.