Less than one-third of patients with glaucoma talk to their doctor about the costs of medications needed to control their disease, reports a study in the December issue of Optometry and Vision Science, the official journal of the American Academy of Optometry. The journal is published by Wolters Kluwer.
High costs are an important barrier to regular use of glaucoma medications, and have been linked to more severe disease and faster progression. Doctor-patient communications might be one way to learn about how cost issues affect patients' adherence to using medications as prescribed.
Medication costs are discussed in less than one-third of glaucoma visits, according to the new study by Catherine Slota, PhD, of RTI International, Research Triangle Park, N.C., and colleagues. They encourage vision care professionals to talk about medication costs with their glaucoma patients—especially those without prescription drug coverage, who may be at increased risk of low medication adherence.
Vision Professionals Should Ask About Costs of Glaucoma Medications
Glaucoma is a chronic, incurable eye disease affecting more than 2 million Americans—a number that is expected to rise as the population ages. "Some of the most commonly utilized treatments require lifelong use, requiring high patient adherence to ensure effectiveness," Dr. Slota and coauthors write.
They analyzed video recordings of 275 office visits between glaucoma patients and ophthalmologists, drawn from a larger study of glaucoma communication. The analysis focused on the frequency and nature of communication regarding the cost of glaucoma medications. Most patients had mild glaucoma and were taking a single medication. Nearly all had health insurance, usually including prescription drug coverage.
Overall, the patient and doctor discussed medication costs in about 31 percent of visits. In about five percent of visits, the patient indicated that the cost of glaucoma medications was a problem—mainly patients who did not have medical insurance.
Some patients said that cost issues affected the way they used their glaucoma medications. As one patient said, "Sometime maybe I forget purposely because they're so darn expensive."
In about 18 percent of visits, the physician suggested possible solutions to cost problems, such as switching to a generic or alternative medication. Other suggestions included ordering a three-month supply, working with the pharmacist, or using prescription drug discount programs.
The patient and doctor talked about health insurance or prescription drug coverage in about 15 percent of visits. These conversations were more likely when the patient was starting glaucoma medications for the first time.
The researchers note some limitations of their study—notably including the fact that nearly all of the patients had health and prescription drug insurance. They suggest further studies of cost issues in uninsured patients and other groups at high risk of nonadherence to glaucoma medications.
The results add to previous evidence that few patients discuss the costs of glaucoma medications with their vision care professionals. Dr. Slota and coauthors conclude, "Physicians should consider bringing up medication cost during glaucoma office visits to prompt a discussion of potential cost-related barriers to medication use."
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Catherine Slota et al. Patient-Physician Communication on Medication Cost during Glaucoma Visits, Optometry and Vision Science (2017). DOI: 10.1097/OPX.0000000000001139