Mali Okada1, Tien Yin Wong2,3, Paul Mitchell4, Bora Eldem5, S James Talks6, Tariq Aslam7, Vincent Daien8, Francisco J Rodriguez9, Richard Gale10, Jane Barratt11, Robert P Finger12, Anat Loewenstein13. 1. Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia. 2. Singapore Eye Research Institute, Singapore National Eye Centre, Singapore. 3. Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore. 4. Westmead Institute for Medical Research, University of Sydney, Sydney, Australia. 5. Department of Ophthalmology, Hacettepe University, Ankara, Turkey. 6. The Newcastle upon Tyne Hospitals NHS Foundation, Newcastle upon Tyne, United Kingdom. 7. Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, The University of Manchester School of Health Sciences, Manchester, United Kingdom. 8. Montpellier University Hospital, Montpellier, France. 9. Fundación Oftalmologica Nacional, Universidad del Rosario School of Medicine, Bogotá, Colombia. 10. Department of Ophthalmology, York Teaching Hospital NHS Foundation Trust, York, United Kingdom. 11. International Federation on Ageing, Toronto, Ontario, Canada. 12. Department of Ophthalmology, University of Bonn, Bonn, Germany. 13. Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Abstract
Importance: Poor adherence or persistence to treatment can be a barrier to optimizing clinical practice (real-world) outcomes to intravitreal injection therapy in patients with neovascular age-related macular degeneration (nAMD). Currently, there is a lack of consensus on the definition and classification of adherence specific to this context. Objective: To describe the development and validation of terminology on patient nonadherence and nonpersistence to anti-vascular endothelial growth factor therapy. Design, Setting, and Participants: Following a systematic review of currently used terminology in the literature, a subcommittee panel of retinal experts developed a set of definitions and classification for validation. Definitions were restricted to use in patients with nAMD requiring intravitreal anti-vascular endothelial growth factor therapy. Validation by the full nAMD Barometer Leadership Coalition was established using a modified Delphi approach, with predetermined mean scores of 7.5 or more signifying consensus. Subsequent endorsement of the definitions was provided from a second set of retinal experts, with more than 50% members agreeing or strongly agreeing with all definitions. Main Outcomes and Measures: Development of consensus definitions for the terms adherence and persistence and a classification system for the factors associated with treatment nonadherence or nonpersistence in patients with nAMD. Results: Nonadherence was defined as missing 2 or more treatment or monitoring visits over a period of 12 months, with a visit considered missed if it exceeded more than 2 weeks from the recommended date. Nonpersistence was defined by nonattendance or an appointment not scheduled within the last 6 months. The additional terms planned discontinuation and transfer of care were also established. Reasons for treatment nonadherence and nonpersistence were classified into 6 dimensions: (1) patient associated, (2) condition associated, (3) therapy associated, (4) health system and health care team associated, (5) social/economic, and (6) other, with subcategories specific to treatment for nAMD. Conclusions and Relevance: This classification system provides a framework for assessing treatment nonadherence and nonpersistence over time and across different health settings in the treatment of nAMD with current intravitreal anti-vascular endothelial growth factor treatments. This may have additional importance, given the potential association of the coronavirus pandemic on adherence to treatment in patients with nAMD.
Importance: Poor adherence or persistence to treatment can be a barrier to optimizing clinical practice (real-world) outcomes to intravitreal injection therapy in patients with neovascular age-related macular degeneration (nAMD). Currently, there is a lack of consensus on the definition and classification of adherence specific to this context. Objective: To describe the development and validation of terminology on patient nonadherence and nonpersistence to anti-vascular endothelial growth factor therapy. Design, Setting, and Participants: Following a systematic review of currently used terminology in the literature, a subcommittee panel of retinal experts developed a set of definitions and classification for validation. Definitions were restricted to use in patients with nAMD requiring intravitreal anti-vascular endothelial growth factor therapy. Validation by the full nAMD Barometer Leadership Coalition was established using a modified Delphi approach, with predetermined mean scores of 7.5 or more signifying consensus. Subsequent endorsement of the definitions was provided from a second set of retinal experts, with more than 50% members agreeing or strongly agreeing with all definitions. Main Outcomes and Measures: Development of consensus definitions for the terms adherence and persistence and a classification system for the factors associated with treatment nonadherence or nonpersistence in patients with nAMD. Results: Nonadherence was defined as missing 2 or more treatment or monitoring visits over a period of 12 months, with a visit considered missed if it exceeded more than 2 weeks from the recommended date. Nonpersistence was defined by nonattendance or an appointment not scheduled within the last 6 months. The additional terms planned discontinuation and transfer of care were also established. Reasons for treatment nonadherence and nonpersistence were classified into 6 dimensions: (1) patient associated, (2) condition associated, (3) therapy associated, (4) health system and health care team associated, (5) social/economic, and (6) other, with subcategories specific to treatment for nAMD. Conclusions and Relevance: This classification system provides a framework for assessing treatment nonadherence and nonpersistence over time and across different health settings in the treatment of nAMD with current intravitreal anti-vascular endothelial growth factor treatments. This may have additional importance, given the potential association of the coronavirus pandemic on adherence to treatment in patients with nAMD.
Authors: Andreas Clemens; Benjamin Gmeiner; Focke Ziemssen; Hansjürgen Agostini; Nicolas Feltgen; Robert P Finger; Christos Haritoglou; Hans Hoerauf; Matthias Iwersen; Martina Porstner Journal: Sci Rep Date: 2022-02-18 Impact factor: 4.379