Purpose

Emerging evidence suggests that the coronavirus disease 2019 (COVID-19) pandemic is disrupting health behaviors such as medication adherence. The objective of this study was to determine whether adherence to ocular hypotensive medication was affected by the pandemic and to identify factors associated with this change.

Design

In this cohort study, we used a controlled interrupted time series design in which the interruption was the declaration of the COVID-19 pandemic in the United States on March 13, 2020. The 300-day monitoring period, which evenly bracketed this declaration, started on October 16, 2019, and ended on August 10, 2020.

Participants

Patients with primary open-angle glaucoma enrolled in an ongoing longitudinal National Institutes of Health-funded study initiated before the onset of the pandemic were selected if they were prescribed ocular hypotensive medication and had adherence data spanning the 300-day period.

Methods

We applied segmented regression analysis using a “slope change following a lag” impact model to obtain the adherence slopes in the periods before and after the segmentation. We compared the 2 slopes using the Davies test.

Main Outcome Measures

The main outcome measure was daily adherence to ocular hypotensive medication, defined as the number of doses taken divided by the number of doses prescribed, expressed in percent. Adherence was measured objectively using Medication Event Monitoring System caps. We assessed the associations between change in adherence and demographic, clinical, and psychosocial factors.

Results

The sample included 79 patients (mean age, 71 years [standard deviation, 8 years]). Segmented regression identified a breakpoint at day 28 after the declaration of the pandemic. The slope in the period after the breakpoint (–0.04%/day) was significantly different from zero (P < 0.001) and from the slope in the period before the breakpoint (0.006%/day; P < 0.001). Mean adherence in the period before the segmentation breakpoint was significantly worse in Black patients (median, IQR: 80.6%, 36.2%) compared with White patients (median, IQR: 97.2%, 8.7%; chi-square, 15.4; P = 0.0004). A significant positive association was observed between the Connor-Davidson resilience score and the change in slope between the periods before and after the breakpoint (P = 0.002).

Conclusions

Adherence to ocular hypotensive medication worsened during the COVID-19 pandemic and seems to be related to patient resilience. This collateral consequence of the pandemic may translate into vision loss that may manifest beyond its containment.

中文翻译：

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2019 年冠状病毒病大流行对原发性开角型青光眼患者降眼压药物依从性的影响

目的

新出现的证据表明，2019 年冠状病毒病 (COVID-19) 大流行正在破坏健康行为，例如服药依从性。本研究的目的是确定对降眼压药物的依从性是否受到大流行的影响，并确定与这种变化相关的因素。

设计

在这项队列研究中，我们使用了一个受控的中断时间序列设计，其中中断是 2020 年 3 月 13 日在美国宣布 COVID-19 大流行。300 天监测期开始于 2019 年 10 月 16 日，并于 2020 年 8 月 10 日结束。

参与者

原发性开角型青光眼患者参加了一项由美国国立卫生研究院资助的在大流行开始前正在进行的纵向研究，如果他们接受了降眼压药物治疗，并且具有跨越 300 天的依从性数据，则他们将被选中。

方法

我们使用“滞后后的斜率变化”影响模型应用分段回归分析，以获得分段前后期间的依从性斜率。我们使用 Davies 检验比较了 2 个斜率。

主要观察指标

主要结果测量是每日对降眼压药物的依从性，定义为服用的剂量数除以处方的剂量数，以百分比表示。使用药物事件监测系统帽客观地测量依从性。我们评估了依从性变化与人口、临床和心理社会因素之间的关联。

结果

样本包括 79 名患者（平均年龄，71 岁 [标准差，8 岁]）。分段回归在宣布大流行后的第 28 天确定了一个断点。断点后时期的斜率（–0.04%/天）与零（P < 0.001）和断点前时期的斜率（0.006%/天；P < 0.001）显着不同。与白人患者（中位数，IQR：97.2%，8.7%；卡方，15.4； P  = 0.0004 ）相比，黑人患者（中位数，IQR：80.6%，36.2%）在分割断点前的平均依从性明显更差 ）。在 Connor-Davidson 弹性评分与断点前后的斜率变化之间观察到显着的正相关（P  = 0.002）。

结论

在 COVID-19 大流行期间，对降眼压药物的依从性恶化，这似乎与患者的恢复力有关。大流行的这种附带后果可能会转化为可能超出其遏制范围的视力丧失。