1
|
Abid A, Baxter SL. Breaking Barriers in Behavioral Change: The Potential of Artificial Intelligence-Driven Motivational Interviewing. J Glaucoma 2024; 33:473-477. [PMID: 38595151 DOI: 10.1097/ijg.0000000000002382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 03/16/2024] [Indexed: 04/11/2024]
Abstract
Patient outcomes in ophthalmology are greatly influenced by adherence and patient participation, which can be particularly challenging in diseases like glaucoma, where medication regimens can be complex. A well-studied and evidence-based intervention for behavioral change is motivational interviewing (MI), a collaborative and patient-centered counseling approach that has been shown to improve medication adherence in glaucoma patients. However, there are many barriers to clinicians being able to provide motivational interviewing in-office, including short visit durations within high-volume ophthalmology clinics and inadequate billing structures for counseling. Recently, Large Language Models (LLMs), a type of artificial intelligence, have advanced such that they can follow instructions and carry coherent conversations, offering novel solutions to a wide range of clinical problems. In this paper, we discuss the potential of LLMs to provide chatbot-driven MI to improve adherence in glaucoma patients and provide an example conversation as a proof of concept. We discuss the advantages of AI-driven MI, such as demonstrated effectiveness, scalability, and accessibility. We also explore the risks and limitations, including issues of safety and privacy, as well as the factual inaccuracies and hallucinations to which LLMs are susceptible. Domain-specific training may be needed to ensure the accuracy and completeness of information provided in subspecialty areas such as glaucoma. Despite the current limitations, AI-driven motivational interviewing has the potential to offer significant improvements in adherence and should be further explored to maximally leverage the potential of artificial intelligence for our patients.
Collapse
Affiliation(s)
- Areeba Abid
- Emory University School of Medicine, Atlanta, GA
| | - Sally L Baxter
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego
- Divison of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, CA
| |
Collapse
|
2
|
Sood S, Al-Aswad LA. The current landscape of social determinants of health in glaucoma (nature and nurture). Clin Exp Ophthalmol 2024; 52:253-255. [PMID: 38627883 DOI: 10.1111/ceo.14381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 03/27/2024] [Accepted: 03/27/2024] [Indexed: 04/19/2024]
Affiliation(s)
- Shefali Sood
- Department of Ophthalmology, Medstar Georgetown University Hospital/Washington Hospital Center, Philadelphia, Pennsylvania, USA
| | - Lama A Al-Aswad
- Department of Ophthalmology, University of Pennsylvania Scheie Eye Institute, Philadelphia, Pennsylvania, USA
- PRECISE Center: School of Engineering and Applied Science University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
3
|
Erras A, Shahrvini B, Weinreb RN, Baxter SL. Review of glaucoma medication adherence monitoring in the digital health era. Br J Ophthalmol 2023; 107:153-159. [PMID: 33858837 PMCID: PMC8517037 DOI: 10.1136/bjophthalmol-2020-317918] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 02/19/2021] [Accepted: 04/05/2021] [Indexed: 02/03/2023]
Abstract
Current glaucoma treatments aim to lower intraocular pressure, often with topical ocular hypotensive medications. Unfortunately, the effectiveness of these medications depends on sustained patient adherence to regimens which may involve instilling multiple medications several times daily. Patient adherence to glaucoma medications is often low. Recent innovations in digital sensor technologies have been leveraged to confirm eyedrop medication usage in real-time and relay this information back to providers. Some sensors have also been designed to deliver medication reminders and notifications as well as assist with correct eyedrop administration technique. Here, we review recent innovations targeted at improving glaucoma medication adherence and discuss their limitations.
Collapse
Affiliation(s)
- Alaa Erras
- Hamilton Glaucoma Center, Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Bita Shahrvini
- Hamilton Glaucoma Center, Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Sally L Baxter
- Hamilton Glaucoma Center, Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA .,Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California, USA
| |
Collapse
|
4
|
Reynolds TL, Ali N, Zheng K. What Do Patients and Caregivers Want? A Systematic Review of User Suggestions to Improve Patient Portals. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2021; 2020:1070-1079. [PMID: 33936483 PMCID: PMC8075519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Significant investments have been made in patient portals in order to provide patients with greater access to their medical records, as well as to other services such as secure electronic communication with their healthcare provider(s). Unfortunately, overall, patient adoption and use of patient portals has been lower than expected. According to the user-centered design philosophy, including end-user voices in all stages of the design process is critical to a technology's success. Thus, as a part of a larger systematic review, we examined the patient portal literature and identified 42 studies that reported patient's or their caregiver's suggestions to improve patient portals. The results suggest that patients and caregivers want patient portals to (i) support human connection (e.g., virtual patient-provider interactions), (ii) give patients more control (e.g., over their medical record) and be designedfor the variation in patient and caregiver experiences, and (iii) be innovative (e.g., provide contextualized medical advice).
Collapse
|
5
|
Hollenhorst CN, Elliott V, Heisler M, Schneider K, Resnicow K, Newman-Casey PA. Patient Experience during the Support, Educate, Empower Glaucoma Coaching Program to Improve Medication Adherence: A Pilot Study. Ophthalmol Glaucoma 2020; 3:238-252. [PMID: 33008556 DOI: 10.1016/j.ogla.2020.04.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/21/2020] [Accepted: 04/27/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE To understand patients' qualitative experiences with the Support, Educate, Empower (SEE) personalized glaucoma coaching program, provide a richer understanding of the components of the intervention that were useful in eliciting behavior change, and understand how to improve the SEE Program. DESIGN A concurrent mixed-methods process analysis. PARTICIPANTS Thirty-nine patients with a diagnosis of any kind of glaucoma or ocular hypertension who were aged ≥40 years, were taking ≥1 glaucoma medication, spoke English, self-administered their eye drops, and had poor glaucoma medication adherence (defined as taking ≤80% of prescribed medication doses assessed via electronic medication adherence monitors) who completed the 7-month SEE Program. METHODS All participants who completed the study were interviewed in-person using a semistructured interview guide after the intervention. Coders conducted qualitative analysis of transcribed interviews using Grounded Theory. Participants were then stratified into groups based on change in adherence, and thematic differences between groups were examined. MAIN OUTCOME MEASURES Themes that emerged from interviews categorized by the number of participants who expressed a theme and the number of representative citations. RESULTS Participants expressed positive views toward the program overall (95%, n = 37/39). They perceived program components as working together to improve their medication adherence. Interactions with the glaucoma coach (38 participants, 184 citations), motivation to aid personal change (38 participants, 157 citations), personalized glaucoma education (38 participants, 149 citations), electronic reminders, and hearing their adherence score (37 participants, 90 citations) were most commonly cited by participants as helpful program elements contributing to improved adherence. Patients expressed a desire for personalized education to be a standard part of glaucoma care. Participants who demonstrated more improvement in adherence had a more trusting attitude toward the adherence score and a greater magnitude of perceived personal need to improve adherence. CONCLUSIONS Participants reported a highly positive response to the in-person glaucoma education and motivational interviewing intervention used in conjunction with automated adherence reminders.
Collapse
Affiliation(s)
- Cecilia N Hollenhorst
- Department of Ophthalmology & Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | | | - Michele Heisler
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan; Department of Health Behavior Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Kevin Schneider
- Department of Ophthalmology & Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Ken Resnicow
- Department of Health Behavior Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Paula Anne Newman-Casey
- Department of Ophthalmology & Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan.
| |
Collapse
|
6
|
Stagg BC, Gupta D, Ehrlich JR, Newman-Casey PA, Stein JD, Kawamoto K, Hess R. The Use of eHealth Practices by United States Patients with Self-Reported Glaucoma. Ophthalmol Glaucoma 2020; 4:71-77. [PMID: 32758543 DOI: 10.1016/j.ogla.2020.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/20/2020] [Accepted: 07/29/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE Patient-oriented eHealth practices (e.g., scheduling appointments on the Internet, communicating with providers online) are an integral part of modern healthcare delivery. It is not known what proportion of United States patients with glaucoma use eHealth and how this use compares with those without glaucoma. DESIGN Cross-sectional study. PARTICIPANTS Participants in the 2016 through 2017 National Health Interview Survey (NHIS), a cross-sectional survey regarding health topics that is administered annually to a nationally representative sample of noninstitutionalized adults in the United States. METHODS Based on the NHIS complex survey design, we calculated the proportion of participants with and without glaucoma who used 5 different eHealth practices (looking up health information on the Internet, requesting or ordering a prescription medication on the Internet, scheduling a medical appointment on the Internet, communicating with healthcare provider online, and using online groups to learn about health topics) during the 12 months before the survey. We performed univariate and multivariate logistic regression to evaluate the association between self-reported glaucoma diagnosis and use of the eHealth practices. MAIN OUTCOME MEASURES Proportion using eHealth practices and odds ratios (ORs). RESULTS Forty thousand four hundred sixty-five survey participants were included in the analysis; 1932 had self-reported glaucoma and 38 533 did not. For those with glaucoma, 46.2% (95% confidence interval [CI], 43.3%-49.0%) used at least one of the eHealth practices in the 12 months before the survey compared with 52.5% (95% CI, 51.5%-53.5%) of those without glaucoma (P < 0.001). After adjusting for confounders, participants with glaucoma were more likely to report use of at least 1 of the eHealth practices compared with those without glaucoma (adjusted OR, 1.22; 95% CI, 1.06-1.40; P = 0.005). CONCLUSIONS In this nationally representative United States population, nearly half of people with glaucoma reported using eHealth practices. Although a lower proportion of people with glaucoma used eHealth practices compared with those without glaucoma, this relationship actually reversed after adjusting for confounders. Because many patients with glaucoma are capable of and already using e-Health, further investment in these technologies may be beneficial.
Collapse
Affiliation(s)
- Brian C Stagg
- John Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah; Department of Population Health Sciences, University of Utah, Salt Lake City, Utah.
| | - Divakar Gupta
- Duke Eye Center, Duke University, Durham, North Carolina
| | - Joshua R Ehrlich
- Center for Eye Policy & Innovation, Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Paula Anne Newman-Casey
- Center for Eye Policy & Innovation, Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Joshua D Stein
- Center for Eye Policy & Innovation, Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah
| | - Rachel Hess
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah; Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| |
Collapse
|
7
|
Aguilar-Rivera M, Erudaitius DT, Wu VM, Tantiongloc JC, Kang DY, Coleman TP, Baxter SL, Weinreb RN. Smart Electronic Eyedrop Bottle for Unobtrusive Monitoring of Glaucoma Medication Adherence. SENSORS 2020; 20:s20092570. [PMID: 32366013 PMCID: PMC7248824 DOI: 10.3390/s20092570] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/22/2020] [Accepted: 04/25/2020] [Indexed: 11/16/2022]
Abstract
Glaucoma, the leading cause of irreversible blindness, affects >70 million people worldwide. Lowering intraocular pressure via topical administration of eye drops is the most common first-line therapy for glaucoma. This treatment paradigm has notoriously high non-adherence rates: ranging from 30% to 80%. The advent of smart phone enabled technologies creates promise for improving eyedrop adherence. However, previous eyedrop electronic monitoring solutions had awkward medication bottle adjuncts and crude software for monitoring the administration of a drop that adversely affected their ability to foster sustainable improvements in adherence. The current work begins to address this unmet need for wireless technology by creating a “smart drop” bottle. This medication bottle is instrumented with sensing electronics that enable detection of each eyedrop administered while maintaining the shape and size of the bottle. This is achieved by a thin electronic force sensor wrapped around the bottle and underneath the label, interfaced with a thin electronic circuit underneath the bottle that allows for detection and wireless transmission to a smart-phone application. We demonstrate 100% success rate of wireless communication over 75 feet with <1% false positive and false negative rates of single drop deliveries, thus providing a viable solution for eyedrop monitoring for glaucoma patients.
Collapse
Affiliation(s)
- Marcelo Aguilar-Rivera
- Department of Bioengineering, University of California San Diego, La Jolla, San Diego, CA 92093, USA; (M.A.-R.); (D.T.E.); (V.M.W.); (D.Y.K.); (T.P.C.)
| | - Dieanira T. Erudaitius
- Department of Bioengineering, University of California San Diego, La Jolla, San Diego, CA 92093, USA; (M.A.-R.); (D.T.E.); (V.M.W.); (D.Y.K.); (T.P.C.)
| | - Vincent M. Wu
- Department of Bioengineering, University of California San Diego, La Jolla, San Diego, CA 92093, USA; (M.A.-R.); (D.T.E.); (V.M.W.); (D.Y.K.); (T.P.C.)
| | - Justin C. Tantiongloc
- Department of Computer Science and Engineering, University of California San Diego, La Jolla, San Diego, CA 92093, USA;
| | - Dae Y. Kang
- Department of Bioengineering, University of California San Diego, La Jolla, San Diego, CA 92093, USA; (M.A.-R.); (D.T.E.); (V.M.W.); (D.Y.K.); (T.P.C.)
| | - Todd P. Coleman
- Department of Bioengineering, University of California San Diego, La Jolla, San Diego, CA 92093, USA; (M.A.-R.); (D.T.E.); (V.M.W.); (D.Y.K.); (T.P.C.)
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, San Diego, CA 92093, USA;
| | - Sally L. Baxter
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, San Diego, CA 92093, USA;
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, San Diego, CA 92093, USA
| | - Robert N. Weinreb
- Department of Bioengineering, University of California San Diego, La Jolla, San Diego, CA 92093, USA; (M.A.-R.); (D.T.E.); (V.M.W.); (D.Y.K.); (T.P.C.)
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, San Diego, CA 92093, USA;
- Correspondence: ; Tel./Fax: +1-858-534-8824
| |
Collapse
|
8
|
Newman-Casey PA, Niziol LM, Gillespie BW, Janz NK, Lichter PR, Musch DC. The Association between Medication Adherence and Visual Field Progression in the Collaborative Initial Glaucoma Treatment Study. Ophthalmology 2020; 127:477-483. [PMID: 31932093 PMCID: PMC7093219 DOI: 10.1016/j.ophtha.2019.10.022] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 10/08/2019] [Accepted: 10/17/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To evaluate the relationship between medication adherence and visual field progression in participants randomized to the medication arm of the Collaborative Initial Glaucoma Treatment Study (CIGTS). DESIGN The CIGTS was a randomized, multicenter clinical trial comparing initial treatment with topical medications to trabeculectomy for 607 participants with newly diagnosed glaucoma. PARTICIPANTS Three hundred seven participants randomized to the medication arm of the CIGTS. METHODS Participants were followed up at 6-month intervals for up to 10 years. Self-reported medication adherence and visual fields were measured. Medication adherence was assessed by telephone from responses to the question, "Did you happen to miss any dose of your medication yesterday?" The impact of medication adherence on mean deviation (MD) over time was assessed with a linear mixed regression model adjusting for the effects of baseline MD and age, cataract extraction, interactions, and time (through year 8, excluding time after crossover to surgery). Medication adherence was modeled as a cumulative sum of the number of prior visits where a missed dose of medication was reported. MAIN OUTCOME MEASURE Mean deviation over time. RESULTS Three hundred seven subjects (306 with adherence data) were randomized to treatment with topical medications and followed up for an average of 7.3 years (standard deviation, 2.3 years). One hundred forty-two subjects (46%) reported never missing a dose of medication over all available follow-up, 112 patients (37%) reported missing medication at up to one third of visits, 31 patients (10%) reported missing medication at one third to two thirds of visits, and 21 patients (7%) reported missing medication at more than two thirds of visits. Worse medication adherence was associated with loss of MD over time (P = 0.005). For subjects who reported never missing a dose of medication, the average predicted MD loss over 8 years was 0.62 dB, consistent with age-related loss (95% confidence interval [CI], 0.17-1.06; P = 0.007); subjects who reported missing medication doses at one third of visits had a loss of 1.42 dB (95% CI, 0.86-1.98; P < 0.0001); and subjects who reported missing medication doses at two thirds of visits showed a loss of 2.23 dB (95% CI, 1.19-3.26; P < 0.0001). CONCLUSIONS This longitudinal assessment demonstrated a statistically and clinically significant association between medication nonadherence and glaucomatous vision loss.
Collapse
Affiliation(s)
- Paula Anne Newman-Casey
- Department of Ophthalmology and Visual Sciences, Medical School, University of Michigan, Ann Arbor, Michigan.
| | - Leslie M Niziol
- Department of Ophthalmology and Visual Sciences, Medical School, University of Michigan, Ann Arbor, Michigan
| | - Brenda W Gillespie
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Nancy K Janz
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Paul R Lichter
- Department of Ophthalmology and Visual Sciences, Medical School, University of Michigan, Ann Arbor, Michigan
| | - David C Musch
- Department of Ophthalmology and Visual Sciences, Medical School, University of Michigan, Ann Arbor, Michigan; Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
9
|
Schachat AP. Quality Improvement. Ophthalmol Retina 2019; 3:541-542. [PMID: 31277793 DOI: 10.1016/j.oret.2019.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 04/01/2019] [Accepted: 04/01/2019] [Indexed: 06/09/2023]
|