Glaucoma is the second leading cause of blindness in the world, with a substantial economic impact on its disease population. Treatments for glaucoma include prescription eye drops, laser surgery or microsurgery. Prescription eye drops are typically the first approach and are prescribed for life-long use. These medications are effective in slowing the progression of the disease, however they are reliant on appropriate medication adherence. Unfortunately, adherence to medications is a serious problem in this disease population, allowing the progression of glaucoma to more advanced and costly stages. Previous research has found about a four-fold difference in the average direct cost of glaucoma treatment in early- stage versus end-stage patients. Patient-physician communication has been found to be influential in improving medication adherence and persistence in other chronic disease states. Although, the glaucoma literature often cites cost as a significant barrier to adherence, the extent and nature of these discussions has not been previously studied in glaucoma. The proposed research is a secondary data analysis of patient interview and videotape office visits. These videotapes were collected from 6 ophthalmologic sites across the United States from 2009-2012 including 15 ophthalmologists and 279 glaucoma patients. Quantitative analysis employing logistic regression will be conducted to examine the influence of patient-physician discussion of medication cost problems on medication adherence while controlling for a number of patient, physician and medication characteristics. Logistic regression will also be used to investigate the association between physician and patient characteristics and medication cost discussion. The proposed research will also employ qualitative methods to describe the types of discussions surrounding medication cost. Understanding how ophthalmologists communicate with their patients regarding medication cost and the effects these discussions have on adherence are crucial in improving patient care. The findings from this proposal can be used to prioritize physician-patient discussions during glaucoma visits and potentially improve health outcomes of glaucoma patients. This proposal will also inform researchers about how to guide future interventions aimed at improving patient adherence in glaucoma or other chronic conditions. If certain aspects of medication cost discussions are related to improved medication adherence, intervention studies can then be designed to formulate strategies to improve communication on cost during ophthalmologic visits that could be integrated into practice.

Public Health Relevance

Glaucoma is the second leading cause of blindness in the world with a substantial economic impact on its disease population. Proper adherence to medications has the ability to slow the progression of glaucoma and greatly reduce the economic burden experienced by this disease. This proposed research will examine the extent and nature of patient-physician communication of medication cost, the association between patient and physician characteristics and discussion of medication cost and the relationship between discussion of medication cost problems and adherence to glaucoma medications.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Dissertation Award (R36)
Project #
Application #
Study Section
HSR Health Care Research Training SS (HCRT)
Program Officer
Willis, Tamara
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of North Carolina Chapel Hill
Schools of Pharmacy
Chapel Hill
United States
Zip Code