Identification of noncompliant glaucoma patients using Bayesian networks and the Eye-Drop Satisfaction Questionnaire

Jean-Philippe Nordmann¹, Christian Baudouin¹, Jean-Paul Renard², Philippe Denis³, Antoine Regnault⁴, Gilles Berdeaux^5,6
1Hôpital des Quinzes-Vingt, Paris; ²Hôpital du Val de Grâce, Paris; ³Hôpital Edouard Herriot, Lyon; ⁴Mapi Values, Lyon; ⁵Alcon France, Rueil-Malmaison; ⁶Conservatoire National des Arts et Métiers, Paris, France

Objective: To identify poorly compliant glaucoma patients, using the Eye-Drop Satisfaction Questionnaire (EDSQ).
Methods: This was an observational cross-sectional study with compliance data collected by an electronic monitoring device. Patients with primary open-angle glaucoma or ocular hypertension completed the EDSQ, a six-dimension self-reported questionnaire addressing "treatment concern", "disease concern", "patient–clinician relationship", "positive beliefs", "treatment convenience", and "self-declared compliance". A Bayesian network (BN) was applied to explore compliance associations with EDSQ.
Results: Among 169 patients who completed the EDSQ, 113 had valid Travalert^® data, of whom 25 (22.1%) demonstrated low compliance. All six EDSQ dimensions were associated directly, or indirectly, with compliance. Two profiles exhibited low compliance, ie, patients aged younger than 77.5 years with a poor patient–physician relationship and self-declared poor compliance and patients aged older than 77.5 years with a poor patient–physician relationship and self-declared good compliance. The third profile showed high compliance, ie, patients aged younger than 77.5 years with a good patient-physician relationship and self-declared good compliance.
Conclusion: Our results confirm a central role for the patient–physician relationship in the compliance process. Age, self-declared compliance, and patient satisfaction with the patient–physician relationship are all dimensions worth exploring before glaucoma medication is switched or proceeding to laser treatment or surgery.

Keywords: glaucoma, compliance, risk factors, patient satisfaction