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영어

Background: Medication persistence is important in treatment effectiveness for glaucoma patients. This study aims to estimate the persistence of topical glaucoma medication and evaluate the risk of the continuity of care for non-persistence and costs. Methods: This retrospective study analyzed the national health insurance service sample cohort data covering the South Korean population. All patients initiating topical medications from 2011 to 2018 were followed up until 2019. Patients were classified into three groups according to the continuity of care index (COCI): high (COCI=1), medium (1>COCI>0.5), and low (0.5>COCI). Non-persistence was defined as a gap of more than 90 days in refills or a switch/addition of medications. Cox proportional hazard model was used to estimate hazard ratios (HR) of non-persistence, and generalized linear model was used to estimate the cost ratios of COCI and medications. Results: A total of 8062 patients were identified. 21-44% of patients discontinued their first treatment at 1 year, depending on COCI and medications. Prostaglandin analogs (HR=0.71, 95% CI 0.66-0.77) and COCI (low vs. high: 1.49, 1.31-1.59; medium vs. high: 1.23, 1.17-1.29) were associated with the non-persistence. The medium COCI group spent more cost compared to the high group (cost ratio of low vs. high: 0.95, 0.90-0.99; medium vs. high: 1.12, 1.07-1.16). Conclusions: The persistence rate for glaucoma medications in Korea is low, but continuity of care can improve that. High continuity based on solid physician-patient relationships and effective patient education would be essential to nudge patients to stay persistent.