手帳持参による緑内障治療のアドヒアランスの変化

Changes in patients' adherence to glaucoma medication by carrying data booklets

要約　目的：緑内障患者に手帳を持参させることでアドヒアランスが変化した報告。対象と方法：1年間にわたり2か月ごとの受診予約があり，緑内障手帳を持っていない緑内障患者230名を対象とした。男性114名，女性116名で，年齢は18～87歳，平均67歳である。手帳を新規に交付し，以後1年間の持参率を調査し，交付前と1年後の点眼治療の状況を面接調査した。結果：12か月間の調査を204名が完了した。2，6，12か月後の手帳の持参率は，73％，90％，98％であり，有意に増加した（p＜0.0001）。アドヒアランス不良患者は，調査開始時の69名（34％）から12か月後の55名（27％）に減少したが，有意差はなかった（p＝0.1）。調査開始時と12か月後の1か月間に点眼しなかった平均回数は，2.1±4.5回と1.1±1.8回で，有意に減少した（p＝0.0083）。どの時点でも，手帳の持参回数と1か月間に点眼しなかった回数は有意に相関していた。結論：手帳を持参させることで，緑内障への点眼治療のアドヒアランスが改善したが，不十分であった。

Abstract.　Purpose：To report changes in patients' adherence to glaucoma medication by carrying data booklets. Cases and Method：This prospective study was made on 230 glaucoma patients who were scheduled to be seen at an interval of two-months. The series comprised 114 males and 116 females. The age ranged from 18 to 87 years,average 67 years. Patient were given a data booklet and were advised to bring the booklet at each visit. Patients were interviewed before and one year after receiving the booklet and were asked about adherence to topical medication. Results：Interview after one year was completed by 204 patients. Data booklet was carried by 73％,90％ and 98％ of patients at 2,6 and 12 months respectively. The rate increased significantly over time（p＜0.0001）. There was no change in the number of patient who showed poor adherence to therapeutic regimen（p＝0.1）. Patients failed to instill eyedrops at an average of 2.1±4.5 times during the first month and 1.1±1.8 times during the last month of study. The difference was significant（p＝0.0083）. The rate of failure was positively correlated with that of non-carrying the booklet. Conclusion：Asking the patient to carry the glaucoma booklet resulted in better adherence to topical treatment.