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Tabuchi H, Nishimura K, Akada M, Ishikami T, Shirakami T, Kamiura N, Kiuchi Y. Real-world evaluation of novel eye drop bottle sensors: Cloud-based AI support for eye drop adherence. Heliyon 2024; 10:e34167. [PMID: 39092249 PMCID: PMC11292234 DOI: 10.1016/j.heliyon.2024.e34167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/30/2024] [Accepted: 07/04/2024] [Indexed: 08/04/2024] Open
Abstract
Purpose To understand real-world eye drop adherence among glaucoma patients and evaluate the performance of our proposed cloud-based support for eye drop adherence (CASEA). Design Prospective, observational case series. Methods Setting: The Department of Ophthalmology at Tsukazaki Hospital. Patient or study population: Glaucoma patients treated at the hospital from May 2021 to September 2022, with 61 patients initially enrolled. Intervention or observation procedures: Pharmacists guided eye drop administration before the study. Changes in bottle orientation were detected using an accelerometer attached to the container, and acceleration waveforms and date/time data were recorded. Patients visited the clinic during the 4th and 8th weeks to report their eye drop administration, and the data were uploaded to the cloud. Main outcome measures: Two AI models (B-LSTM) were created to analyze the eye drop bottle movement time-series data for patients treating one or both eyes. The models were evaluated by comparing the true administration status with the AI model judgment. Results Four of the 61 study subjects dropped out. The remaining 57 patients achieved recall, precision, and accuracy values of 98.6 %, 98.6 %, and 95.9 %, respectively, for the two-eyes model and 95.8 %, 98.8 %, and 95.6 % for the one-eye model. Three low-accuracy participants (77.1 %, 71.0 %, and 81.0 %) improved to 100 %, 99.1 %, and 100 %, respectively, after undergoing an additional 8-week performance validation using an aid-type container designed to ensure that the bottle was fully inverted during instillation. Conclusions CASEA precisely monitored daily eye drop adherence and enhanced treatment efficacy by identifying patients with difficulty self-medicating. This system has the potential to improve glaucoma patient outcomes by supporting adherence.
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Affiliation(s)
- Hitoshi Tabuchi
- Department of Technology and Design Thinking for Medicine, Hiroshima University, Hiroshima, Japan
- Department of Ophthalmology, Tsukazaki Hospital, Himeji, Japan
| | | | - Masahiro Akada
- Department of Ophthalmology, Tsukazaki Hospital, Himeji, Japan
| | | | | | - Naotake Kamiura
- Graduate School of Engineering, University of Hyogo, Himeji, Japan
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Bedrood S, Berdahl J, Sheybani A, Singh IP. Alternatives to Topical Glaucoma Medication for Glaucoma Management. Clin Ophthalmol 2023; 17:3899-3913. [PMID: 38111854 PMCID: PMC10726774 DOI: 10.2147/opth.s439457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 11/22/2023] [Indexed: 12/20/2023] Open
Abstract
Topical glaucoma medications have favorable safety and efficacy, but their use is limited by factors such as side effects, nonadherence, costs, ocular surface disease, intraocular pressure fluctuations, diminished quality of life, and the inherent difficulty of penetrating the corneal surface. Although traditionally these limitations have been accepted as an inevitable part of glaucoma treatment, a rapidly-evolving arena of minimally invasive surgical and laser interventions has initiated the beginnings of a reevaluation of the glaucoma treatment paradigm. This reevaluation encompasses an overall shift away from the reactive, topical-medication-first default and a shift toward earlier intervention with laser or surgical therapies such as selective laser trabeculoplasty, sustained-release drug delivery, and micro-invasive glaucoma surgery. Aside from favorable safety, these interventions may have clinically important attributes such as consistent IOP control, cost-effectiveness, independence from patient adherence, prevention of disease progression, and improved quality of life.
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Affiliation(s)
| | | | - Arsham Sheybani
- John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
- Department of Ophthalmology and Visual Sciences, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
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Wu G, Lee DA, Zhao W, Wong A, Sidhu S. ChatGPT: is it good for our glaucoma patients? FRONTIERS IN OPHTHALMOLOGY 2023; 3:1260415. [PMID: 38983063 PMCID: PMC11182305 DOI: 10.3389/fopht.2023.1260415] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/01/2023] [Indexed: 07/11/2024]
Abstract
Purpose Our study investigates ChatGPT and its ability to communicate with glaucoma patients. Methods We inputted eight glaucoma-related questions/topics found on the American Academy of Ophthalmology (AAO)'s website into ChatGPT. We used the Flesch-Kincaid test, Gunning Fog Index, SMOG Index, and Dale-Chall readability formula to evaluate the comprehensibility of its responses for patients. ChatGPT's answers were compared with those found on the AAO's website. Results ChatGPT's responses required reading comprehension of a higher grade level (average = grade 12.5 ± 1.6) than that of the text on the AAO's website (average = 9.4 grade ± 3.5), (0.0384). For the eight responses, the key ophthalmic terms appeared 34 out of 86 times in the ChatGPT responses vs. 86 out of 86 times in the text on the AAO's website. The term "eye doctor" appeared once in the ChatGPT text, but the formal term "ophthalmologist" did not appear. The term "ophthalmologist" appears 26 times on the AAO's website. The word counts of the answers produced by ChatGPT and those on the AAO's website were similar (p = 0.571), with phrases of a homogenous length. Conclusion ChatGPT trains on the texts, phrases, and algorithms inputted by software engineers. As ophthalmologists, through our websites and journals, we should consider encoding the phrase "see an ophthalmologist". Our medical assistants should sit with patients during their appointments to ensure that the text is accurate and that they fully comprehend its meaning. ChatGPT is effective for providing general information such as definitions or potential treatment options for glaucoma. However, ChatGPT has a tendency toward repetitive answers and, due to their elevated readability scores, these could be too difficult for a patient to read.
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Affiliation(s)
- Gloria Wu
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, United States
| | - David A Lee
- Department of Ophthalmology, McGovern Medical School, University of Texas Health Science Center, Houston, TX, United States
| | - Weichen Zhao
- Department of Biological Sciences, University of California Davis, Davis, CA, United States
| | - Adrial Wong
- Department of Biological Sciences, University of California Davis, Davis, CA, United States
| | - Sahej Sidhu
- Department of Biology, Santa Clara University, Santa Clara, CA, United States
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Kinast RM, Sanchez FG, Rees JP, Yeh K, Gardiner SK, Dawes J, Johnston ML, Porter JD, Klei V, Mansberger SL. Eye Drop Adherence With an Eye Drop Bottle Cap Monitor. J Glaucoma 2023; 32:369-373. [PMID: 37053080 PMCID: PMC10132997 DOI: 10.1097/ijg.0000000000002166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/21/2022] [Indexed: 04/14/2023]
Abstract
PRCIS An eye drop bottle cap monitor with audio and visual alarms measured eye drop adherence in 50 subjects with glaucoma. Baseline adherence rates were too high to test if the alarms could improve adherence. PURPOSE To determine if an eye drop bottle cap monitor can measure and improve adherence. MATERIALS AND METHODS The Devers Drop Device (D3, Universal Adherence LLC) was designed to measure eye drop adherence by detecting bottle cap removal and replacement, and it can provide text, visual and audio alerts when a medication is due. In Stage 1, we determined baseline adherence for 50 subjects using a nightly eye drop over a 25-day period. Subjects with less than 90% baseline adherence were eligible for Stage 2. In Stage 2, we randomized subjects to receive either no reminder or automated D3 alerts for their nightly eye drop over a subsequent 25-day period. We defined adherence as the proportion of drops administered within 3 hours of the subjects' scheduled dosing time. Subjects completed 3 questions regarding satisfaction with the device and willingness to pay. RESULTS The D3 monitor remained attached to the eye drop bottle cap for the duration of the study and collected adherence data in all 50 patients. In Stage 1, the mean adherence rate was 90 ± 18% (range 32-100%). Forty (80%) subjects had an adherence rate greater than 90%. Adherence rates were too high in Stage 1 to adequately test the effects of reminders in Stage 2. Ninety-eight percent (49/50) and 96% (48/50) of subjects agreed "the device always stayed attached to the bottle cap" and "I was able to use the device to take the drops", respectively. Patients would pay $61±83 (range $0-400) for a similar device to improve adherence. CONCLUSIONS The D3 can measure eye drop adherence. Research subjects reported high satisfaction and willingness to pay for an eye drop bottle cap monitor. Glaucoma patients have high adherence when they are being monitored, and future studies with research subjects screened for poor adherence may further determine the benefit of electronic monitoring of adherence with and without electronic reminders.
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Affiliation(s)
| | | | | | | | | | - Jacob Dawes
- Oregon State University, School of Electrical Engineering and Computer Science
| | - Matthew L Johnston
- Oregon State University, School of Electrical Engineering and Computer Science
| | - J David Porter
- Oregon State University, School of Mechanical Industrial and Manufacturing Engineering, Corvallis, OR
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Newman-Casey PA, Resnicow K, Winter S, Niziol LM, Darnley-Fisch D, Imami N, McHaney-Conner P, Musch DC, Mitchell J, Heisler M. The Support, Educate, Empower personalized glaucoma coaching trial design. Clin Trials 2023; 20:192-200. [PMID: 36855233 PMCID: PMC10023277 DOI: 10.1177/17407745221136571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND Glaucoma is a chronic disease that affects 3 million Americans. Glaucoma is most often asymptomatic until very late in its course when treatment is more difficult and extensive peripheral vision loss has already occurred. Taking daily medications can mitigate this vision loss, but at least half of people with glaucoma do not take their prescribed medications regularly. The purpose of this study is to improve glaucoma medication adherence among those with medically treated glaucoma and poor self-reported adherence using the Support, Educate, Empower personalized coaching program. METHODS/DESIGN This study is a two-site randomized controlled trial enrolling 230 participants with poor self-reported glaucoma medication adherence. The trial has two arms, an intervention arm and a control arm. Participants in the intervention arm receive personalized glaucoma education and motivational interviewing-based coaching over 6 months from a trained non-physician interventionist for three in-person sessions with between visit phone calls for check-ins where current adherence level is reported to participants. Participants also can elect to have visual, audio, text or automated phone call medication dose reminders. Participants in the control arm continue usual care with their physician and receive non-personalized glaucoma educational materials via mail in parallel to the three in-person coaching sessions to control for glaucoma knowledge content. All participants receive a medication adherence monitor. The primary outcome is the proportion of prescribed doses taken on schedule during the 6-month period. The secondary outcome is glaucoma related distress. The exploratory outcome is intraocular pressure. DISCUSSION The personalized education and motivational-interviewing-based intervention that we are testing is comprehensive in that it addresses the wide range of barriers to adherence that people with glaucoma encounter. Leveraging a custom-built web-based application to generate the personalized content and the motivational-interviewing-based prompts to guide the coaching sessions will make this program both replicable and scalable and can be integrated into clinical care utilizing trained non-physician providers. Although this type of self-management support is not currently reimbursed for glaucoma as it is for diabetes, this trial could help shape future policy change should the intervention be found effective.
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Affiliation(s)
- Paula Anne Newman-Casey
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Ken Resnicow
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Suzanne Winter
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Leslie M Niziol
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | | | - Nauman Imami
- Department of Ophthalmology, Henry Ford Health System, Detroit, MI, USA
| | | | - David C Musch
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Jamie Mitchell
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Michele Heisler
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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Fırat P, Dikci S, Can A, Türkoğlu E. Evaluation of medication adherence of glaucoma patients during the COVID-19 pandemic. J Fr Ophtalmol 2023; 46:11-18. [PMID: 36435659 PMCID: PMC9671694 DOI: 10.1016/j.jfo.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate changes in the medication adherence of glaucoma patients during the COVID-19 pandemic and the factors influencing medication adherence. MATERIALS AND METHODS This cross-sectional study included a total of 197 glaucoma patients who were followed for at least six months in the Glaucoma Unit of the Ophthalmology Department of Inonu University, Faculty of Medicine. Patients were given a 28-item questionnaire, including the eight-item Morisky Medication Adherence Questionnaire, to evaluate medication adherence. Demographic and clinical data were recorded. P<0.05 was considered statistically significant. RESULTS Interruption of glaucoma clinic visits during the pandemic was reported by 82 (41.6%) patients. Nonadherence was reported by 56 patients (28.4%) (95% confidence interval: 22.1-34.7). For these patients, the most common reasons for nonadherence were forgetfulness (50%), the inability to receive a prescription for the drug (10.7%) and being busy (10.7%). Factors influencing nonadherence were determined to be younger age, female gender, interruption of glaucoma clinic visits and high-income levels (P˂0.05). CONCLUSION Interruption of glaucoma clinic visits during the COVID-19 pandemic and the resulting inability to have medications prescribed resulted in patient nonadherence with medication use.
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Affiliation(s)
- P.G. Fırat
- Inonu University, Faculty of Medicine, Department of Ophthalmology, Malatya, Turkey
| | - S. Dikci
- Inonu University, Faculty of Medicine, Department of Ophthalmology, Malatya, Turkey,Corresponding author
| | - A. Can
- Inonu University, Faculty of Medicine, Department of Ophthalmology, Malatya, Turkey
| | - E.B. Türkoğlu
- Akdeniz University, Faculty of Medicine, Department of Ophthalmology, Antalya, Turkey
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Medication Adherence and Common Barriers for Caregivers of Preschool Children with Pediatric Glaucoma. J Ophthalmol 2022. [DOI: 10.1155/2022/6389822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Purpose. To investigate the medication adherence among caregivers of preschool children with pediatric glaucoma and to elucidate common barriers leading to poor adherence. Methods. A cross-sectional study. Caregivers of preschool children with pediatric glaucoma completed a questionnaire on demographic information of caregivers, demographic and disease characteristics of children, caregivers-reported medication adherence (by an adapted Morisky Adherence Scale), and possible 13 barriers. Results. Overall 132 questionnaires were considered valid. Thirty-six percent of all reported poor medication adherence. Caregivers’ age and self-evaluated knowledge about pediatric glaucoma showed a significant difference between the adherent and nonadherent groups (
). Nineteen percent of all reported only one barrier as important, 65% cited multiple barriers, and 16% cited no barriers. Anxiety and depression were cited as important by most caregivers in both groups. Univariate logistic regression analysis demonstrated that difficulty with the acquisition of medications (OR, 2.5; 95% CI, 1.1–5.7;
), difficulty with medication schedule (OR, 2.3; 95% CI, 1.0–5.0;
), and high expenses for medications (OR, 4.8; 95% CI, 1.4–15.9;
) were significantly associated with higher odds of poor adherence. Conclusions. Over one-third of caregivers of preschool children with pediatric glaucoma were in poor medication adherence. Nearly two-thirds of caregivers cited multiple barriers simultaneously as important hindrances to medication usage. Anxiety and depression, difficulty with the acquisition of medications, difficulty with the medication schedule, and high expenses for medications were prominent barriers. Individualized solutions should be provided according to reported barriers by each caregiver and the other most common barriers.
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Intracanalicular Dexamethasone Insert or Topical Prednisolone Following iStent and Hydrus Surgery for Glaucoma. J Glaucoma 2022; 31:694-699. [PMID: 35439795 PMCID: PMC9362341 DOI: 10.1097/ijg.0000000000002037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 04/02/2022] [Indexed: 02/04/2023]
Abstract
PRCIS Using an intracanalicular dexamethasone insert or topical prednisolone following iStent and Hydrus surgery provided similar short-term control of postoperative inflammation. PURPOSE The purpose of this study was to compare postoperative inflammation in patients who received an intracanalicular dexamethasone insert or topical prednisolone after iStent or Hydrus insertion during cataract surgery. PATIENTS AND METHODS Patients receiving a dexamethasone insert after iStent or Hydrus insertion were included and compared with age-matched controls who received topical prednisolone. Preoperative data were recorded. Postoperative inflammatory cell and the proportion of patients with zero anterior chamber cells was recorded at month 1. Postoperative intraocular pressure (IOP) and rate of cystoid macular edema were recorded at months 1 and 3. RESULTS Forty eyes receiving topical prednisolone were compared with 35 eyes receiving a dexamethasone insert after iStent or Hydrus insertion. The mean postoperative inflammatory cell for the topical group at month 1 was 0.2±0.3, and the dexamethasone group, 0.3±0.5 ( P =0.816). Overall, 70% of patients in the topical group had zero anterior chamber cell at postoperative month 1 compared with 75.8% in the dexamethasone group ( P =0.583). The mean preoperative IOP for the topical group was 18.8±5.5 and the dexamethasone group was 17.1±4.1 ( P =0.064). Mean postoperative IOP for the topical group at months 1 and 3 was 17.6±6.4 and 15.1±3.1, respectively and the dexamethasone group, 17.5±4.8 and 15.0±3.4, respectively ( P =0.772 and 0.884). One patient developed cystoid macular edema in each group. CONCLUSION There was no statistically significant difference in the proportion of patients who had zero anterior chamber cell at postoperative month 1 between groups receiving intracanalicular dexamethasone insert or topical prednisolone.
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Poleon S, Sabbagh N, Racette L. Whitecoat Adherence in Patients With Primary Open-Angle Glaucoma. Front Med (Lausanne) 2022; 9:867884. [PMID: 35665331 PMCID: PMC9160987 DOI: 10.3389/fmed.2022.867884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/26/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose Whitecoat adherence refers to improved medication adherence in the days surrounding clinic visits. This may lead to clinical measures that are not representative of those outside of clinical encounters. In glaucoma, whitecoat adherence to prescribed hypotensive therapy may lead to intraocular pressure readings within the target range, which may impact clinical decision-making. We aimed to quantify and identify factors associated with whitecoat adherence. Methods In this cohort study, patients with primary open-angle glaucoma were selected from an ongoing longitudinal NIH-funded study if they used hypotensive eyedrops, had a clinic visit during the parent study, and had adherence data during the 28 days evenly bracketing the clinic visit. Adherence within the implementation phase was measured using Medication Event Monitoring System (MEMS) caps. Wilcoxon tests were used to compare mean adherence between the following periods: Pre14-4 (days 14 to 4 preceding the clinic visit) and Pre3-1 (days 3 to 1 preceding the visit); Post1-3 (days 1 to 3 following the clinic visit) and Post4-14 (days 4 to 14 following the visit). Analyses were performed in the full sample and in patients with optimal (≥80%, n = 49) and suboptimal adherence (<80%, n = 17). Results Sixty-six patients were included, of which 51.5% were female. Mean age was 70.8 ± 8.1 years. In the 6 months evenly bracketing the clinic visit, mean and median adherence were 86.3% (standard deviation = 17.7) and 95.6% (interquartile range = 21.2), respectively. Overall, mean adherence increased from Pre14-4 to Pre3-1 (85.5% ± 21.2 to 88.5% ± 23.2, p = 0.01) and decreased from Post1-3 to Post4-14 (87.0 ± 23.9 to 84.9 ± 23.3, p = 0.02). In patients with optimal adherence, adherence increased from Pre14-4 to Pre3-1 (94.0 ± 11.7 to 97.7 ± 7.4, p = 0.001) and from Post1-3 to Post4-14 (95.2 ± 12.0 to 95.4 ± 5.7, p = 0.007). Whitecoat adherence was not observed in patients with suboptimal adherence. Conclusion We documented the presence of whitecoat adherence in this cohort. Due to its potential impact on clinical outcomes and decisions, providers should remain vigilant for this phenomenon and prioritize it during patient-provider discussions.
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Affiliation(s)
- Shervonne Poleon
- Department of Optometry and Vision Science, School of Optometry, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Nouran Sabbagh
- Department of Internal Medicine, University of Alabama at Birmingham, Montgomery, AL, United States
| | - Lyne Racette
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
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Martin CA, Khan S, Lee R, Do A, Sridhar J, Crowell E, Bowden E. Readability and Suitability of Online Glaucoma Patient Education Materials. Ophthalmol Glaucoma 2022; 5:525-530. [PMID: 35301989 DOI: 10.1016/j.ogla.2022.03.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/28/2022] [Accepted: 03/09/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the quality, content, readability, and accountability of information found online for glaucoma. DESIGN Cross-sectional study. PARTICIPANTS 13 websites containing glaucoma patient education materials were analyzed for this study. METHODS An online Google search was conducted using the keyword glaucoma. 13 medical website results were selected for analysis. Each website was assessed by three independent reviewers for suitability, readability, and accountability. The standardized Suitability Assessment of Materials (SAM) tool was used to evaluate the quality and content of information on each website. The Flesch reading ease (FRE), Flesch-Kincaid Grade Level (FKGL), Coleman-Liau Index (CLI), Simple Measure of Gobbledygook Index (SMOG), Automated Readability Index (ARI), and Linsear Write Formula (LWF) scores were used to assess readability of the websites. The Journal of the American Medical Association (JAMA) Accountability Benchmarks were used to evaluate each website's accountability. MAIN OUTCOME MEASURES SAM score, FRE, FKGL, CLI, SMOG, ARI, LWF scores, and JAMA Accountability Benchmarks. RESULTS The average SAM score for all the websites included in this study was 18 points out of a possible 34 points. Eyewiki.org was the lowest scoring website (11.7 ± 0.6 points), while aao.org and nei.nih.gov were the highest scoring websites (26.0 ± 1.0 points and 26.0 ± 2.6 points, respectively). Three content graders in this study were in moderate agreement (kappa statistic = 0.59). The average Flesch Reading Ease (FRE) scores among all websites was 47.0 (95% confidence interval (CI), 39.3 - 54.7). The average reading grade score among all websites was 11.2 (95% CI, 10.0 - 12.4). Two of the thirteen websites (15.4%) satisfied all 4 JAMA accountability criteria. CONCLUSIONS There is significant variation in the content and quality of freely available online glaucoma education material. The material is generally either not suitable or only adequate for use. Most websites reviewed are written at a reading grade level higher than that recommended for patient education materials.
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Affiliation(s)
- Cole A Martin
- Mitchel and Shannon Wong Eye Institute, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | - Saima Khan
- Mitchel and Shannon Wong Eye Institute, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | - Rachel Lee
- New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
| | - Anna Do
- Eye Care of San Diego, San Diego, CA, USA
| | - Jayanth Sridhar
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eric Crowell
- Mitchel and Shannon Wong Eye Institute, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | - Eileen Bowden
- Mitchel and Shannon Wong Eye Institute, Dell Medical School at the University of Texas at Austin, Austin, TX, USA.
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11
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Yang Y, Lockwood A. Topical ocular drug delivery systems: Innovations for an unmet need. Exp Eye Res 2022; 218:109006. [DOI: 10.1016/j.exer.2022.109006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 02/06/2022] [Accepted: 02/20/2022] [Indexed: 02/07/2023]
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McGlumphy EJ, Dosto NO, Johnson TV, Quigley HA. Electronically Monitored Corticosteroid Eye Drop Adherence after Trabeculectomy Compared to Surgical Success. Ophthalmol Glaucoma 2022; 5:379-387. [PMID: 34995818 DOI: 10.1016/j.ogla.2021.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 12/24/2021] [Accepted: 12/29/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare electronically measured adherence with topical corticosteroid drops to outcomes of glaucoma surgery. DESIGN This prospective cohort study included eyes undergoing surgery from August 2019 to January 2021 and followed for up to 1 year. PARTICIPANTS All patients were recruited from the Glaucoma Center of Excellence at the Wilmer Eye Institute, Johns Hopkins. Eligible patients had either primary open angle or angle closure glaucoma, were ≥18 years old, and underwent either trabeculectomy (with or without cataract surgery) or tube-shunt implantation. INTERVENTION Patients were instructed on use of an eyedrop monitoring device (Kali Drop®), with knowledge that it would be used to record postoperative corticosteroid instillation in real time. MAIN OUTCOMES Adherence to a regimen of corticosteroid eye drops during the first 5 postoperative weeks; achievement of target intraocular pressure (IOP) at 6 weeks, 6 months to 1 year after surgery; and bleb morphology at 1 year. RESULTS Among 90 patients, adherence was 90 ± 14% overall and 81 ± 16% during q2h dosing. Target IOP was achieved at final visit (6 months or 1 year) in 81% (59/73) without reoperation. Eyes with a higher ratio of drops taken vs prescribed were significantly more likely to achieve target IOP at 6 months/1 year (p=0.05). Total adherence was better in younger persons, eyes with less field loss, and patients of one particular surgeon (p<0.03). Percent adherence during every 2 hours (q2h) dosing was higher in eyes with higher target IOP (p=0.01). No adherence outcome was significantly related to race, sex, bleb morphology, postoperative pain, or post-operative anterior chamber inflammation. Adherence values did not significantly correlate with adherence questionnaire data (predicted mean = 70 ± 17%, actual mean = 91 ± 13% adherent, p < 0.001). CONCLUSION Adherence with frequent postoperative eye drops was high and can be successfully monitored remotely. Surgical success was greater among eyes with nearly ideal adherence and was poorer in older persons and those with more advanced glaucoma. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03402802.
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Affiliation(s)
- Elyse J McGlumphy
- Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Niccolo O Dosto
- Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Thomas V Johnson
- Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Harry A Quigley
- Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Abstract
Importance People with disabilities tend to have lower medication adherence. Glaucoma medication adherence has been scantly studied for people with disability. Objective To determine whether disability leads to reduced glaucoma medication adherence and whether this decrease varies by type of disability. Design, Setting, and Participants This population-based case-control study enrolled individuals with glaucoma and without disability, who were followed up until they received disability certification. All patients in Taiwan with confirmed glaucoma in 1 or both eyes were identified using National Health Insurance claims data. All patients with glaucoma who required glaucoma medication adherence (confirmed glaucoma, suspected glaucoma, and patients with ocular hypertension) and had newly obtained disability status after December 31, 2013, were identified and matched to counterparts without disability based on age and sex. The study period was January 1, 1997, to December 31, 2017. Data were analyzed from May 2021 to August 2021. Exposures All patients were followed up until they obtained confirmed disability status, which was identified using the National Disability Registry in Taiwan. Main Outcomes and Measures Secondary adherence was measured using frequencies of glaucoma medication refills and outpatient visits at 1-year and 2-year intervals. Results A total of 46 468 patients with glaucoma (23 234 with disability and 23 234 without disability; 24 508 men [52.7%]; 21 960 women [47.3%] mean [SD] age, 72.5 [14.3] years) were included in the study. Overall, the frequency of glaucoma outpatient visits was higher in people with disabilities than those without disabilities both before the index dates (difference, 0.64 [95% CI, 0.57-0.72]; P < .001) and after the index dates (difference, 0.34 [95% CI, 0.27-0.41]; P < .001) when using 1-year intervals. However, when stratified by the type of disability, having limb disability, being in a vegetative state, and having dementia were associated with fewer outpatient visits and lower medication adherence (at a maximum of 17.60 [95% CI, 8.90-26.30] percentage points lower; P < .001) compared with people without disability. Adjusted regression results revealed that people with visual disability had a mean of 2.50 (95% CI, 2.34-2.67) times more glaucoma outpatient visits than their matches who were disability free (P < .001). Conclusions and Relevance Certain types of disability can reduce glaucoma medication adherence by up to 17.60%. Policies targeting medication adherence should consider these disability types.
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Affiliation(s)
- Chiun-Ho Hou
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan.,Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Ophthalmology, Chang Gung Memorial Hospital, Xiamen, People's Republic of China.,Department of Medicine, College of Medicine, Chang Gung University, Taiwan
| | - Christy Pu
- Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Shu YH, Wu J, Luong T, Mattox C, Fang EN, Lee BL, Jones JP, Campbell J, Shih V, Zhao C, Fong DS. Topical Medication Adherence and Visual Field Progression in Open-angle Glaucoma: Analysis of a Large US Health Care System. J Glaucoma 2021; 30:1047-1055. [PMID: 34669680 PMCID: PMC8635266 DOI: 10.1097/ijg.0000000000001943] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 09/03/2021] [Indexed: 11/26/2022]
Abstract
PRCIS Modeling of visual field and pharmacy data (Kaiser Permanente, 2001 to 2014) from open-angle/pseudoexfoliation glaucoma patients in clinical practice indicated a significant inverse association between the level of medication adherence and rate of visual field progression. PURPOSE The aim was to quantify the effect of nonadherence to topical hypotensive medication on glaucomatous visual field progression in clinical practice. METHODS Retrospective analysis of combined visual field and pharmacy data from Kaiser Permanente Southern California's HealthConnect electronic health record database. Patients with a diagnosis of primary open-angle glaucoma or pseudoexfoliation glaucoma (2001 to 2011) and ≥3 subsequent visual field tests of the same Swedish Interactive Threshold Algorithm type were followed up from first medication fill to final visual field test. Medication adherence (proportion of days covered) was estimated from pharmacy refill data. A conditional growth model was used to estimate the effect of adherence level in modifying the progression of mean deviation over time after adjusting for potential confounders, including age, sex, race/ethnicity, baseline glaucoma severity, and comorbidity. RESULTS In total, 6343 eligible patients were included in the study and followed for (mean) 5.8 years; average treatment adherence during follow-up was 73%. After controlling for confounders and the interaction between time and baseline disease severity, the model indicated that mean deviation progression was significantly (P=0.006) reduced by 0.006 dB per year for each 10% (absolute) increase in adherence. Model estimates of time to glaucoma progression (mean deviation change -3 dB from baseline) were 8.3 and 9.3 years for patients with adherence levels of 20% and 80%, respectively. CONCLUSIONS Improving patient adherence to topical glaucoma medication may result in slower deterioration in visual function over time.
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Affiliation(s)
- Yu-Hsiang Shu
- Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena
| | - Jun Wu
- Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena
| | - Tiffany Luong
- Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena
| | | | - Ervin N. Fang
- Department of Ophthalmology, Southern California Permanente Medical Group, Los Angeles
| | - Brian L. Lee
- Department of Ophthalmology, Southern California Permanente Medical Group, West Los Angeles
| | | | | | | | | | - Donald S. Fong
- Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena
- Eye Monitoring Center, Kaiser Permanente Southern California and Department of Ophthalmology, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, CA
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15
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Advances and challenges in the nanoparticles-laden contact lenses for ocular drug delivery. Int J Pharm 2021; 608:121090. [PMID: 34530102 DOI: 10.1016/j.ijpharm.2021.121090] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/04/2021] [Accepted: 09/09/2021] [Indexed: 12/14/2022]
Abstract
The delivery of drugs that target ocular tissues is challenging due to the physiological barriers of the eye like tear dilution, nasolacrimal drainage, blinking, tear turnover rate and low residence time Drug-laden contact lenses can be a possible solution to overcome some of these challenges. Nanoparticles are being extensively studied as novel systems for loading drugs into therapeutic contact lenses. The versatile features of the organic and inorganic nanoparticles and their diverse physicochemical properties make it possible to load and sustain drug release from the contact lenses. Nevertheless, several issues remains to be solved before its clinical application and commercialization such as changes in contact lens swelling (water content), transmittance, protein adherence, surface roughness, tensile strength, ion and oxygen permeability and drug leaching during contact lens manufacture. However, clinical studies demonstrated the potential of therapeutic contact lenses to manage the scientific, commercial and regulatory challenges to make its place in the market. This review highlights the different methodologies used to fabricate nanoparticle-laden contact lenses and highlights the major advances and challenges to commercialization.
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16
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Recent advances in ophthalmic preparations: Ocular barriers, dosage forms and routes of administration. Int J Pharm 2021; 608:121105. [PMID: 34537269 DOI: 10.1016/j.ijpharm.2021.121105] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/27/2021] [Accepted: 09/13/2021] [Indexed: 12/16/2022]
Abstract
The human eye is a complex organ with unique anatomy and physiology that restricts the delivery of drugs to target ocular tissues/sites. Recent advances in the field of pharmacy, biotechnology and material science have led to development of novel ophthalmic dosage forms which can provide sustained drug delivery, reduce dosing frequency and improve the ocular bioavailability of drugs. This review highlights the different anatomical and physiological factors which affect ocular bioavailability of drugs and explores advancements from 2016 to 2020 in various ophthalmic preparations. Different routes of drug administration such as topical, intravitreal, intraocular, juxtascleral, subconjunctival, intracameral and retrobulbar are discussed with their advances and limitations.
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17
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Adherence With Glaucoma Medications: Barriers to Success and Prospects for Improvement. CURRENT OPHTHALMOLOGY REPORTS 2021. [DOI: 10.1007/s40135-021-00273-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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18
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Kim S, Tong B, Lee J, Borodge D, Kooner K. Lifestyle Counseling for Medication Adherence in Glaucoma. Clin Ophthalmol 2021; 15:3521-3529. [PMID: 34429583 PMCID: PMC8380305 DOI: 10.2147/opth.s321351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/26/2021] [Indexed: 12/03/2022] Open
Abstract
Background Medication adherence in glaucoma patients remains sub-par despite proven benefits of regular administration. The objective was to analyze medication adherence before and after lifestyle counseling in patients with ocular hypertension (OHT) or primary open-angle glaucoma (POAG) (mild, moderate, severe). Methods Prospective cohort study from May to July 2018 at a single academic center. From 391 consecutive records, 247 were excluded based on exclusion criteria with 28 patients not meeting inclusion criteria resulting in the final sample of 116 patients (33 had OHT, 83 had POAG – 28 mild, 39 moderate, 16 severe). Scripted lifestyle counseling focusing on diet, exercise, vitamin intake, stress management, and medication adherence was administered by a team of trained medical students. Primary outcome measure was self-reported medication adherence, defined as not missing an eye drop administration in the past month. A 2–3 week follow-up with scripted telephone survey assessing medication adherence, diet, and exercise was collected. Results At baseline, in 116 patients, 59.5% were adherent to their medication with a breakdown of 42.4% OHT, 64.3% mild, 66.7% moderate, and 68.7% severe and an increasing trend in medication adherence was found across increasing disease severity (p=0.055). Of the 76 (65.5%) patients reached for follow-up, 17 (22.4%) became adherent following lifestyle counseling (p=0.02) increasing overall adherence to 78.9% from 62.5%. Conclusion In our study, comprehensive lifestyle counseling succeeded in increasing medication adherence in patients with OHT and POAG.
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Affiliation(s)
- Sandy Kim
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Betty Tong
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jessica Lee
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Darara Borodge
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Karanjit Kooner
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Ophthalmology, Veterans Affairs North Texas Health Care System, Dallas, TX, USA
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Buehne KL, Rosdahl JA, Muir KW. Aiding Adherence to Glaucoma Medications: A Systematic Review. Semin Ophthalmol 2021; 37:313-323. [PMID: 34402384 DOI: 10.1080/08820538.2021.1963788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To provide a comprehensive assessment of the strategies studied to date that focus on improving glaucoma medication adherence. METHODS A systematic review of the literature was conducted in MEDLINE (PubMed), Embase (Elsevier), and Scopus (Elsevier) from inception to March 1, 2021, of publications describing a device or strategy used to improve glaucoma medication adherence. RESULTS 42 studies described by 50 papers were included. Five categories were identified: reminder systems, medication simplifications, behavioral change programs, education, and alternative engagement strategies. CONCLUSION Most studies (40 of the 42) addressed the question of improved adherence directly, with 26 finding improved adherence. Notably, 14 examined the clinical effects of the intervention, either in terms of intraocular pressure (IOP) or visual fields. Only three found an improvement in IOP. None demonstrated a between group difference in visual field progression.
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Affiliation(s)
- Kristen L Buehne
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Jullia A Rosdahl
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Kelly W Muir
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA.,Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
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20
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Mueller CM, Ward L, O'Keefe GAD. Health Literacy, Medication Adherence, and Quality of Life in Patients With Uveitis. Ocul Immunol Inflamm 2021; 30:1060-1067. [PMID: 33739905 DOI: 10.1080/09273948.2020.1861304] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: To evaluate health literacy, medication adherence, and quality of life (QOL) in uveitis patients.Methods: Cross-sectional quality improvement study using questionnaires of health literacy (Short Assessment of Health Literacy), adherence (Beliefs about Medicine Questionnaire), and QOL (12-item Short Form Health Survey).Results: Sixty patients were surveyed: 57% women, 80% identified as Black, and 42% with schooling beyond high school. Forty-three percent of the patients had poor health literacy, with lower scores among those with less schooling (p < .01). Necessity scores were higher for multiple providers (p = .02). Necessity (p = .03) and Concerns (p < .01) scores were higher for patients seeing a rheumatologist. Patients had lower physical (p < .01) and mental QOL (p < .01) than the general US population.Conclusions: Uveitis patients reported many barriers to care. Despite strong perceptions of treatment necessity, there were significant concerns, especially among patients seeing a rheumatologist. We recommend multidisciplinary care, individualized education, and counseling regarding medication safety and the necessity to improve adherence.
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Affiliation(s)
- Claire M Mueller
- Department of Ophthalmology, Oregon Health & Science University Casey Eye Institute, Resident, Portland, OR, USA
| | - Laura Ward
- Department of Biostatistics and Bioinformatics, Associate Faculty, Emory University, Atlanta, GA, USA
| | - Ghazala A Datoo O'Keefe
- Department of Ophthalmology, Emory University School of Medicine, Assistant Professor of Ophthalmology, Section of Vitreoretinal Surgery and Diseases, Section of Uveitis and Vasculitis, Atlanta, GA, USA
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21
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Novack GD, Caspar JJ. Peri-Operative Intracameral Antibiotics: The Perfect Storm? J Ocul Pharmacol Ther 2020; 36:668-671. [PMID: 32580612 DOI: 10.1089/jop.2020.0034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In our University journal club we discussed a large, retrospective study of cataract surgery endophthalmitis rates before and after instituting the use of an intracameral fluoroquinolone antibiotic. We identified several factors involved in the use of off-label, compounded moxifloxacin in intraocular surgery. The introduction of phacoemulsification for cataract surgery led to the potential for smaller incisions. Intraocular lens technology improved to allow for foldable lenses, obviating the requirement to enlarge the incision. This allowed for clear corneal incisions, which unfortunately allow bidirectional passage of liquid. Preservatives were introduced into multi-dose ophthalmic products in the mid 20th century to retard microbial growth. However, more recently, chronic use of benzalkonium chloride has led to concerns about concerns about conjunctival toxicity, especially in patients with ocular surface disease. In the formulation of ocular moxifloxacin, developers were able to develop a "self-preserved", multi-dose product. Other concerns with eyedrops include varying levels of adherence and performance, and the expansion of compounding pharmacies from a named-patient basis to widespread national delivery, with concerns for lower quality. Integrating these factors, use of intracameral moxifloxacin as a prophylactic during cataract and other anterior segment surgery has become a standard of care in much of the U.S. We are concerned that the current position is on a narrow ledge-the standard of care for millions of surgeries each year based upon off-label, compounting use of a single product. We discuss possible ramifications and solutions to this public health issue.
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Affiliation(s)
- Gary D Novack
- Department of Ophthalmology & Visual Sciences, University of California, Davis, California, USA.,PharmaLogic Development, Inc., San Rafael, California, USA
| | - Jeffrey J Caspar
- Department of Ophthalmology & Visual Sciences, University of California, Davis, California, USA
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22
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Abstract
The use of contact lenses as ocular drug delivery systems has been considered intuitive for decades. However, at this time, there are no approved products using such systems. In this article, we review the challenges with current therapies, pharmacokinetics, and pharmacodynamics of different drug classes and the patient population. In addition, we note the relative lack of clinical studies, and list potential products in active development at this time. In particular, we address the alignment of time course of the therapeutic need, the pharmacokinetics of the molecule, and the delivery characteristics of the systems (e.g., pulsatile vs. zero-order). We also discuss the needs of various populations including the elderly (who may have motor and cognitive issues as well as presbyopia) and the young. While a contact lens delivery system may also provide refractive correction, to date, most of the studies have used noncorrective (plano) lenses. We also considered nanotechnology-based carrier systems. We generalize the development of contact lens delivery systems to all ocular delivery systems in which there are relatively few product approvals and long development times.
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Affiliation(s)
- Gary D Novack
- Department of Ophthalmology & Visual Sciences, University of California, Davis, California, USA
- PharmaLogic Development, Inc., San Rafael, California, USA
| | - Melissa Barnett
- Department of Ophthalmology & Visual Sciences, University of California, Davis, California, USA
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23
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The Effect of Patient Education and Telemedicine Reminders on Adherence to Eye Drops for Glaucoma. Ophthalmol Glaucoma 2020; 3:369-376. [PMID: 32980041 DOI: 10.1016/j.ogla.2020.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/08/2020] [Accepted: 05/13/2020] [Indexed: 01/14/2023]
Abstract
PURPOSE To determine the improvement in patient adherence to topical ocular hypotensive therapy by introducing a personalized illustrated medication reference chart and telereminder. DESIGN Prospective randomized controlled clinical trial. PARTICIPANTS Fifty-nine patients with glaucoma who were using at least 3 or more eye drops were recruited from the ophthalmology clinic at the National University Hospital of Singapore. METHODS Participants were randomized into 3 groups: control, reference chart only, and reference chart with telereminder. They completed a survey on demographics, barriers to glaucoma medication adherence, and self-adherence (measured by the Morisky adherence scale) before and 6 weeks after intervention. Logistic regression analysis was performed on the barriers that contribute to nonadherence and paired t tests were conducted for the preimplementation and postimplementation effects of intervention on adherence score. MAIN OUTCOME MEASURES Changes in mean adherence score based on the Morisky adherence scale before and after intervention in participants from all 3 groups. RESULTS In our study, 71% of participants who were nonadherent to medications had multiple barriers to adherence, with lack of self-efficacy and forgetfulness being the most common factors. Only the reference chart with telereminder group showed a statistically significant increase in mean adherence score, from 7.18 to 7.69 (P = 0.047). CONCLUSIONS Adherence to medication in chronic diseases like glaucoma is an important healthcare issue to address. Most of these patients have poor adherence because of multiple factors, and hence interventions aimed at improving adherence should be multifaceted to target these barriers.
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24
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Hou CH, Lin KK, Lee JS, Pu C. Medication Adherence in Patients With Glaucoma After Cancer Diagnosis. Am J Ophthalmol 2020; 213:88-96. [PMID: 31945329 DOI: 10.1016/j.ajo.2020.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 12/20/2019] [Accepted: 01/03/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE To determine the association between cancer diagnosis and medication adherence in patients with glaucoma. DESIGN Cohort study. METHODS Setting: Population-based. StudyPopulation: All patients with confirmed glaucoma in one or both eyes. All patients were aged 20 years or older. Patients who developed cancer within 2 year of a confirmed glaucoma diagnosis or who were dead within 2 year after a confirmed cancer diagnosis were excluded. Intervention orObservationProcedure(s): Individuals without cancer but with a confirmed glaucoma diagnosis were followed until they received a confirmed cancer diagnosis. They were then matched with a group of patients with confirmed glaucoma who did not develop cancer during the study period. MainOutcomeMeasure(s): Secondary adherence measured using medication possession ratio (MPR) at 1-year, 2-year, and 2-year-average intervals. RESULTS For both patients with cancer and their matches, MPR was the highest when measured at 1-year intervals. MPR was 0.379 (95% CI: 0.370-0.388) for the cancer group and 0.313 (95% CI: 0.308-0.319) for the cancer-free group. MPR measured using 1-year intervals decreased by 17.4% after cancer diagnosis (P < .001). MPR measured using 2-year and 2-year-average intervals decreased by 10.4% (P < .001) and 9.21% (P < .001), respectively. CONCLUSIONS Cancer diagnosis leads to lower medication adherence in patients with glaucoma. To improve medication adherence in patients with glaucoma who also have cancer, policies should directly target the burden associated with having cancer that tends to create barriers for medication refills, rather than targeting risk factors that are also applicable to patients with glaucoma but without cancer.
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25
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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.
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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
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26
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Quiroz-Mercado H, Ivri E, Gonzalez-Salinas R, Kourtis IC, Gilbert J, Pérez-Vázquez JF, Blumenkranz M, Jiménez-Román J, Marcellino G. Clinical Evaluation of a Novel Electromechanical Topical Ocular Drug Delivery System: Two Phase 1 Proof of Concept Studies. Clin Ophthalmol 2020; 14:139-147. [PMID: 32021079 PMCID: PMC6980856 DOI: 10.2147/opth.s221749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 11/29/2019] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Self-administration of topical ophthalmic therapies remains challenging for many patients as errors due to improper technique are common. The aim of the current studies was to evaluate a novel electromechanical topical ocular drug delivery device designed to facilitate precise dosing and accurate delivery with substantially lower drug exposure than conventional eye drops. PATIENTS AND METHODS Two randomized Phase 1 studies were performed to evaluate the efficacy and safety of a single dose of a topical ophthalmic solution administered as a ~9 μL microfluid stream via the test device compared with a ~30-40 μL drop delivered via conventional dropper in healthy subjects (Trial 1) and glaucoma patients (Trial 2). In Trial 1, a 1% tropicamide/2.5% phenylephrine solution was administered via the test device in one eye and by conventional dropper in the contralateral eye. Pupil dilation was measured at 30 min intervals post-instillation and subject comfort was assessed using a visual analogue scale (range, 0-100). In Trial 2, patients were randomized to receive latanoprost 0.005% via the test device or conventional dropper. Intraocular pressure was measured at baseline and 4-8 hrs post-instillation. RESULTS In Trial 1 (N=20), mean (SD) pupil diameter 30 mins post-instillation increased by 3.4 (0.9) and 3.5 (1.0) mm in the test and control eyes, respectively. The mean comfort score was 81.7 for the test device versus 57.3 for conventional dropper delivery. In Trial 2 (N=18), the mean change in intraocular pressure following administration of latanoprost was -5.0 (1.8) and -4.3 (3.3) mm Hg in the test and control groups, respectively. No serious adverse events were observed in either study. CONCLUSION Administration of a single dose of topical ophthalmic therapy via an electromechanical drug delivery device resulted in comparable effects on pupil dilation and intraocular pressure with lower drug exposure and increased patient comfort compared with conventional dropper delivery.
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Affiliation(s)
- Hugo Quiroz-Mercado
- Association to Prevent Blindness, Hospital Sanchez-Bulnes, Mexico City, Mexico
| | - Ehud Ivri
- Kedalion Therapeutics Inc., Menlo Park, CA, USA
| | | | | | | | | | | | - Jesús Jiménez-Román
- Association to Prevent Blindness, Hospital Sanchez-Bulnes, Mexico City, Mexico
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Psychometric Properties of the Glaucoma Treatment Compliance Assessment Tool (GTCAT) in a Brazilian Population. J Glaucoma 2019; 27:257-265. [PMID: 29369851 DOI: 10.1097/ijg.0000000000000876] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To determine the psychometric properties of a reduced version of the Glaucoma Treatment Compliance Assessment Tool (GTCAT), which was translated to Brazilian Portuguese. PATIENTS AND METHODS We translated into Portuguese the GTCAT using validated techniques and administered it to a group of glaucoma patients using at least 1 ocular hypotensive eye drop medication. We used principal components analysis to determine construct validity, Rasch analysis, and Cronbach α for internal consistency reliability, frequency analysis for floor and ceiling effects, and Spearman ρ for test-retest reliability. RESULTS We included 76 glaucoma patients. Principal component analysis loaded 14 questions into 7 components that were consistent with the Health Belief Model. The components were related to "barriers due to lack of drops," "self-efficacy," "experience of negative effects of the disease," "well-being," "general glaucoma knowledge," "glaucoma symptoms," and "cues-to-action." No statements had floor or ceiling effects, and all statements had acceptable test-retest reliability. Components had internal consistency Cronbach α reliability between 0.125 and 0.794. and average Spearman ρ reliability was 0.73, ranging from 0.44 to 1.00. According to Rasch analysis, the mean (±SD) of the person measures was 0.24±0.15 logits, person separation index was 0.58, and person reliability 0.25. CONCLUSIONS The Portuguese-translated version of the GTCAT showed acceptable psychometric properties. With further refinement, clinicians and researchers could use it to better investigate glaucoma adherence issues in the Brazilian population.
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Affiliation(s)
- Alan L. Robin
- Department of Ophthalmology, Johns Hopkins School of Medicine and Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Ophthalmology, The University of Michigan, Ann Arbor, MI, USA
| | - Kelly W. Muir
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
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McClelland JF, Bodle L, Little JA. Investigation of medication adherence and reasons for poor adherence in patients on long-term glaucoma treatment regimes. Patient Prefer Adherence 2019; 13:431-439. [PMID: 31496662 PMCID: PMC6697779 DOI: 10.2147/ppa.s176412] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 12/01/2018] [Indexed: 12/05/2022] Open
Abstract
PURPOSE Long-term treatment adherence for a chronic asymptomatic condition is a demanding task for many patients. Treating progressive glaucoma can also be confounding for physicians, particularly when management relies on assumption of adherence. This study investigated associations between self-reported adherence and frequency of medication changes due to glaucoma progression. METHODS A total of 128 participants with primary open angle glaucoma were recruited from glaucoma clinics in Flinders Eye Center, South Australia, and completed confidential questionnaires. Information was obtained regarding beliefs about glaucoma and their treatment. Adherence was assessed using the four-item Morisky, Green and Levine Medication Adherence Questionnaire (MGL). Medical records were analyzed for the number of medication changes, due to glaucoma progression. RESULTS Adherence to topical glaucoma medication was categorized as 'high' in 41.4% (Morisky, Green and Levine (MGL). Data were analyzed for behaviors affecting adherence, history of adherence, and reasons for changed adherence. Chi-squared test demonstrated that there was no significant association noted between adherence and changes in medication regime (χ2 (2,128)=0.968, P=0.915); however, a significantly lower adherence was detected if participants had difficulties with their drop regime (χ2 (2,128)=7.24, P=0.027) or had help with drop insertion (χ2 (1,128)=9.77, P=0.008). CONCLUSION This study revealed a higher rate of non-adherence than has previously been demonstrated in other studies. This may be attributed to the unique design of the confidential questionnaire and the independent and sympathetic questioning techniques used. Further work to develop a specific glaucoma medication adherence questionnaire would be valuable to enhance glaucoma management.
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Affiliation(s)
- Julie F McClelland
- Vision Science Research Group, Biomedical Sciences Research Institute, Ulster University, Coleraine, UK
- Correspondence: Julie F McClelland Vision Science Research Group, Biomedical Sciences Research Institute, Ulster University, Cromore Road, Coleraine, BT52 1SA, UKTel +44 0 287 012 4216Fax +44 0 287 012 4504 Email
| | - Lynne Bodle
- Vision Science Research Group, Biomedical Sciences Research Institute, Ulster University, Coleraine, UK
- Department of Ophthalmology, Flinders Medical Centre, Flinders University, Adelaide, SA, Australia
| | - Julie-Anne Little
- Vision Science Research Group, Biomedical Sciences Research Institute, Ulster University, Coleraine, UK
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Refractive adaptation and efficacy of occlusion therapy in untreated amblyopic patients aged 12 to 40 years. Graefes Arch Clin Exp Ophthalmol 2018; 257:379-389. [DOI: 10.1007/s00417-018-4170-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 09/11/2018] [Accepted: 10/16/2018] [Indexed: 10/27/2022] Open
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Barker GT, Mansberger SL. Psychometric Properties of the Reduced Version of the Glaucoma Treatment Compliance Assessment Tool (GTCAT). Ophthalmic Epidemiol 2018; 26:55-62. [PMID: 30204034 DOI: 10.1080/09286586.2018.1516785] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE To measure the psychometric properties of a reduced, 27-statement version of the Glaucoma Treatment Compliance Assessment Tool (GTCAT). METHODS We administered the GTCAT to 183 participants who were using a single bottle of an ocular hypotensive agent, and objectively measured adherence with Medication Event Monitoring System devices over 60 days. Adherence was the number of days with correctly timed bottle openings divided by the total number of study days. Using the 47-statement GTCAT, we created a reduced GTCAT by removing statements that: (1) did not load using Principal Components Analysis (PCA); (2) did not have a univariable association with adherence; or (3) were highly correlated (.75 or higher) with another statement. We assessed the construct validity of the remaining statements using PCA and assessed the predictive validity using multiple logistic regression analysis. RESULTS We removed 20 statements because they did not appear in the PCA analysis; were not predictive of adherence; and/or had high correlation. PCA of the reduced GTCAT (27 statements) extracted 5 components of the Health Belief Model (knowledge, susceptibility, cues-to-action, self-efficacy, and barriers). Multiple regression showed that the 27 statements predicted adherence (Rsq = .11, p = .03). CONCLUSIONS The reduced version of the GTCAT is associated with adherence, which suggests that after external validation, future glaucoma medication adherence studies could use the reduced version to efficiently measure health behaviors and determine the benefit of the GTCAT to develop personalized interventions in glaucoma adherence.
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Affiliation(s)
- Gordon T Barker
- a Devers Eye Institute at Legacy Health , Portland , OR , USA
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Lee CP, Holmes T, Neri E, Kushida CA. Deception in clinical trials and its impact on recruitment and adherence of study participants. Contemp Clin Trials 2018; 72:146-157. [PMID: 30138717 DOI: 10.1016/j.cct.2018.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/27/2018] [Accepted: 08/14/2018] [Indexed: 11/27/2022]
Abstract
Deceptive practices by participants in clinical research are prevalent. It has been shown that as high as 75% of participants withheld information to avoid exclusion from studies. Self-reported adherence has been found to be largely inaccurate. Overcoming deception is a critical issue, since the safety of study participants, the integrity of research data and research resources are at risk. In this review article, we examine deception from the perspective of investigators conducting clinical trials; we describe the types (concealment, fabrication, drug holidays and collusion), prevalence, risks, and predictors of deception, and propose an approach to reduce the impact of deception, especially on adherence, in clinical trials.
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Affiliation(s)
- Chuen Peng Lee
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore.
| | - Tyson Holmes
- Stanford University Human Immune Monitoring Center, Institute for Immunity Transplantation and Infection, Stanford University School of Medicine, Stanford, United States
| | - Eric Neri
- Stanford University School of Medicine, Palo Alto, CA, United States
| | - Clete A Kushida
- Stanford Sleep Medicine Center, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 450 Broadway Street, MC 5704, Pavilion C, 2nd Floor, Redwood City, CA 94063-5704, United States
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Kinast RM, Mansberger SL. Glaucoma Adherence-From Theriac to the Future. Am J Ophthalmol 2018; 191:xiii-xv. [PMID: 29716719 DOI: 10.1016/j.ajo.2018.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 04/05/2018] [Indexed: 11/19/2022]
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Newman-Casey PA, Killeen OJ, Renner M, Robin AL, Lee P, Heisler M. Access to and Experiences with, e-Health Technology Among Glaucoma Patients and Their Relationship with Medication Adherence. Telemed J E Health 2018; 24:1026-1035. [PMID: 29683401 DOI: 10.1089/tmj.2017.0324] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: As online health information becomes common, it is important to assess patients' access to and experiences with online resources. Introduction: We examined whether glaucoma patients' technology usage differs by medication adherence and whether adherence is associated with online education experiences. Materials and Methods: We included 164 adults with glaucoma taking ≥1 glaucoma medication. Participants completed a survey including demographic and health information, the Morisky Adherence Scale, and questions about online glaucoma resource usage. Differences in technology access, adherence, and age were compared with chi-squared, Fisher exact, and two-sample t-tests. Results: Mean age was 66 years. Twenty-six percent reported poor adherence. Eighty percent had good technology access. Seventy-three percent of subjects with greater technology access wanted online glaucoma information and yet only 14% of patients had been directed to online resources by physicians. There was no relationship between technological connectivity and adherence (p = 0.51). Nonadherent patients were younger (mean age 58 years vs. 66 years for adherent patients, p = 0.002). Nonadherence was associated with negative feelings about online searches (68% vs. 42%, p = 0.06). Discussion: Younger, poorly adherent patients navigate online glaucoma resources without physician input. These online searches are often unsatisfying. Technology should be leveraged to create high quality, online glaucoma resources that physicians can recommend to provide guidance for disease self-management.
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Affiliation(s)
- Paula Anne Newman-Casey
- Department of Ophthalmology & Visual Sciences, Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan
| | - Olivia J Killeen
- Department of Ophthalmology & Visual Sciences, Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan
| | - Morgan Renner
- Department of Ophthalmology & Visual Sciences, Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan
| | - Alan L Robin
- Department of Ophthalmology & Visual Sciences, Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan.,Department of Ophthalmology & Visual Sciences, University of Maryland Medical School, Baltimore, Maryland
| | - Paul Lee
- Department of Ophthalmology & Visual Sciences, Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan
| | - Michele Heisler
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
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Bron AM, Garcher CP, Sirbat D, Allaire CM, Lablache-Combier MJ, Trinquand CJ. Comparison of Two Fixed Beta-Blocker-Pilocarpine Combinations. Eur J Ophthalmol 2018; 7:351-6. [PMID: 9457458 DOI: 10.1177/112067219700700408] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose To compare the efficacy and safety of a newly developed ophthalmic solution containing carteolol 2% and pilocarpine (2% (CBS341A) with a timolol 0.5% and pilocarpine 2% fixed combination. Patients and Methods. A randomized, double-masked, multicenter study was conducted in 209 patients with primary open-angle glaucoma or ocular hypertension, whose intraocular pressure (IOP) was higher than 21 mm Hg on bet-blocker twice a day alone. The test medications were administered twice daily for 4 months. IOP was measured at 9 and 11 a.m. at the beginning of the study (with beta-blocker alone) and after one and four months of treatment. Adverse effects were recorded. Results Both combinations caused a similar, statistically significant decrease in IOP. At four months, in the CBS341A group a 2.4 mm Hg (9%) reduction in IOP was achieved at 9 a.m. and 4.1 mm Hg (17.3%) at 11 a.m. compared with respectively 3 mm Hg (11%) and 4.5 mm Hg (19.5%) in the timolol-pilocarpine group. No statistical difference was observed between the two groups in safety and efficacy. Conclusions The carteolol-pilocarpine combination appears as safe and as effective as the timolol-pilocarpine combination in the medical treatment of primary open-angle glaucoma or ocular hypertension.
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Affiliation(s)
- A M Bron
- Department of Ophthalmology, CHU Hôpital General, Dijon, France
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Hostyn P, Le Rebeller MJ, Trinquand C. Fixed Combination of Carteolol and Pilocarpine Eye-Drops: A Double-Blind Randomized Cross-Over Trial versus Carteolol Alone on Intra-Ocular Pressure. Eur J Ophthalmol 2018; 6:17-20. [PMID: 8744845 DOI: 10.1177/112067219600600105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The effects of carteolol 2% and a fixed combination of carteolol 2% and pilocarpine 2% (CBS 341 A) eye-drops on intraocular pressure (I.O.P.) were compared in a multicenter double-blind, cross-over prospective trial. Twenty-eight patients were initially selected after at least three weeks of carteolol 2%, with a morning I.O.P. greater than 21-mmHg. They received 2 drops a day (b.i.d.), in a random order, alternating two weeks of carteolol 2% alone or two weeks of CBS 341 A. After each two-week period a 12-h I.O.P. curve was plotted. Compared to carteolol the combination reduced I.O.P. on average by around 20% (4 mmHg), with maximum effect 4h after instillation. The effectiveness was confirmed after twelve hours. Some side effects were reported with CBS 341 A, due to the well known pharmacological effects of pilocarpine. The new combination could be useful for second-line therapy in glaucoma.
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Affiliation(s)
- P Hostyn
- Department of Ophthalmology, Hôpital Pellegrin Tripode, Bordeaux, France
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Evaluating Eye Drop Instillation Technique and Its Determinants in Glaucoma Patients. J Ophthalmol 2018; 2018:1376020. [PMID: 29850197 PMCID: PMC5911316 DOI: 10.1155/2018/1376020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 03/11/2018] [Indexed: 11/17/2022] Open
Abstract
Aim To evaluate eye drop instillation technique and to explore its determinants in glaucoma patients. Methods One hundred and thirteen patients diagnosed with glaucoma and self-administering topical antiglaucoma eye drops for at least 1 month were evaluated. All patients instilled artificial tear solution in one eye as they would do at home. The whole process was evaluated by two study staff. A comprehensive score system associated with eye drop instillation techniques was used to quantify the instillation technique and explore its determinants such as demographic and clinical characteristics. Results Half of the patients (48.67%) finished the administration of eye drop on first attempt.1.7 eye drops were squeezed out on average. 43 patients (37.17%) got contact with ocular surface or adnexa. Only 19.7% patients had eye drop instillation techniques being defined as well. 11 patients (9.7%) had prior instruction regarding using eye drops, while only 4 patients knew to occlude the tear duct by pressing the dacryocyst area. Older age and worse visual acuity were found to be independent risk factors for worse instillation technique. Conclusions Eye drop instillation technique in glaucoma patients deserves great attention from eye care practitioners during their lifelong follow-up, especially those aged older and have worse visual acuity.
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Awwad S, Mohamed Ahmed AHA, Sharma G, Heng JS, Khaw PT, Brocchini S, Lockwood A. Principles of pharmacology in the eye. Br J Pharmacol 2017; 174:4205-4223. [PMID: 28865239 PMCID: PMC5715579 DOI: 10.1111/bph.14024] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 08/14/2017] [Accepted: 08/17/2017] [Indexed: 12/18/2022] Open
Abstract
The eye is a highly specialized organ that is subject to a huge range of pathology. Both local and systemic disease may affect different anatomical regions of the eye. The least invasive routes for ocular drug administration are topical (e.g. eye drops) and systemic (e.g. tablets) formulations. Barriers that subserve as protection against pathogen entry also restrict drug permeation. Topically administered drugs often display limited bioavailability due to many physical and biochemical barriers including the pre-corneal tear film, the structure and biophysiological properties of the cornea, the limited volume that can be accommodated by the cul-de-sac, the lacrimal drainage system and reflex tearing. The tissue layers of the cornea and conjunctiva are further key factors that act to restrict drug delivery. Using carriers that enhance viscosity or bind to the ocular surface increases bioavailability. Matching the pH and polarity of drug molecules to the tissue layers allows greater penetration. Drug delivery to the posterior segment is a greater challenge and, currently, the standard route is via intravitreal injection, notwithstanding the risks of endophthalmitis and retinal detachment with frequent injections. Intraocular implants that allow sustained drug release are at different stages of development. Novel exciting therapeutic approaches include methods for promoting transscleral delivery, sustained release devices, nanotechnology and gene therapy.
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Affiliation(s)
- Sahar Awwad
- UCL School of PharmacyLondonUK
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of OphthalmologyLondonUK
| | - Abeer H A Mohamed Ahmed
- UCL School of PharmacyLondonUK
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of OphthalmologyLondonUK
| | - Garima Sharma
- UCL School of PharmacyLondonUK
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of OphthalmologyLondonUK
| | - Jacob S Heng
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of OphthalmologyLondonUK
| | - Peng T Khaw
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of OphthalmologyLondonUK
| | - Steve Brocchini
- UCL School of PharmacyLondonUK
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of OphthalmologyLondonUK
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Squeeze Me if You Can: Variability in Force Requirements to Extract a Drop From Common Glaucoma Bottles. J Glaucoma 2017; 25:780-4. [PMID: 27552516 DOI: 10.1097/ijg.0000000000000506] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the force requirements to dispense a single drop from commonly prescribed brand and generic topical glaucoma medications and correlate these findings with pinch strength in a representative patient population. PATIENTS AND METHODS Four bottles of each medication were tested: 2 in the vertical and 2 in the horizontal orientation. Bottles were housed in a customized force gauge apparatus designed to mimic ballpoint fingertip contact with a bottle tip. For all bottles, each of the first 10 dispensed drops was tested and then tests were performed in increments of 10 until the bottle was empty. For each tested drop, the maximum force and displacement were electronically measured. Concurrently, maximum pinch strength was measured on consecutive glaucoma patients. RESULTS A total of 84 bottles from 21 bottle designs were tested. There was significant variability across the designs, with roughly a 7-fold (0.67 to 4.49 kgf) and 4-fold (0.81 to 3.00 kgf) difference in force requirements in the vertical and horizontal positions, respectively. Of 53 enrolled patients in the glaucoma clinic, the mean pinch strength was 5.05 (range, 1.23 to 10.4 kgf) and 4.82 (range, 1.47 to 10.67 kgf) kgf for the right and left hands, respectively. CONCLUSIONS There is statistically significant variability in the force required to squeeze a drop from common glaucoma medications, and a representative sampling of clinic patients suggests that many likely struggle with the force requirements of several bottle designs. These data further support standardization of topical glaucoma drug delivery and design.
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Angelis A, Kanavos P. Multiple Criteria Decision Analysis (MCDA) for evaluating new medicines in Health Technology Assessment and beyond: The Advance Value Framework. Soc Sci Med 2017; 188:137-156. [PMID: 28772164 DOI: 10.1016/j.socscimed.2017.06.024] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 05/12/2017] [Accepted: 06/19/2017] [Indexed: 10/19/2022]
Abstract
Escalating drug prices have catalysed the generation of numerous "value frameworks" with the aim of informing payers, clinicians and patients on the assessment and appraisal process of new medicines for the purpose of coverage and treatment selection decisions. Although this is an important step towards a more inclusive Value Based Assessment (VBA) approach, aspects of these frameworks are based on weak methodologies and could potentially result in misleading recommendations or decisions. In this paper, a Multiple Criteria Decision Analysis (MCDA) methodological process, based on Multi Attribute Value Theory (MAVT), is adopted for building a multi-criteria evaluation model. A five-stage model-building process is followed, using a top-down "value-focused thinking" approach, involving literature reviews and expert consultations. A generic value tree is structured capturing decision-makers' concerns for assessing the value of new medicines in the context of Health Technology Assessment (HTA) and in alignment with decision theory. The resulting value tree (Advance Value Tree) consists of three levels of criteria (top level criteria clusters, mid-level criteria, bottom level sub-criteria or attributes) relating to five key domains that can be explicitly measured and assessed: (a) burden of disease, (b) therapeutic impact, (c) safety profile (d) innovation level and (e) socioeconomic impact. A number of MAVT modelling techniques are introduced for operationalising (i.e. estimating) the model, for scoring the alternative treatment options, assigning relative weights of importance to the criteria, and combining scores and weights. Overall, the combination of these MCDA modelling techniques for the elicitation and construction of value preferences across the generic value tree provides a new value framework (Advance Value Framework) enabling the comprehensive measurement of value in a structured and transparent way. Given its flexibility to meet diverse requirements and become readily adaptable across different settings, the Advance Value Framework could be offered as a decision-support tool for evaluators and payers to aid coverage and reimbursement of new medicines.
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Affiliation(s)
- Aris Angelis
- Department of Health Policy and Medical Technology Research Group, LSE Health, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, United Kingdom.
| | - Panos Kanavos
- Department of Health Policy and Medical Technology Research Group, LSE Health, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, United Kingdom
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Moore DB, Beck J, Kryscio RJ. An objective assessment of the variability in number of drops per bottle of glaucoma medication. BMC Ophthalmol 2017; 17:78. [PMID: 28532424 PMCID: PMC5441018 DOI: 10.1186/s12886-017-0473-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 05/15/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The purpose of this study is to evaluate the number of eyedrops available per bottle of a variety of commonly prescribed glaucoma medications. METHODS Six bottles of each glaucoma medication were tested: three each in the vertical and horizontal orientations. Bottles were housed in a customized force gauge apparatus designed to mimic ballpoint fingertip contact with a bottle. At a standard rate, all drops were expressed from each bottle and counted with an automated drop counter. Simultaneously, bottle volume was measured and drop size and number were also estimated. The main outcome measures were: total number of drops, volume per bottle and drops per milliliter (mL) of glaucoma medication. RESULTS A total of 192 bottles from 32 bottle designs and manufacturers were tested. Twenty-two of the 32 bottle designs had a significantly different mean number of drops in the vertical and horizontal positions, with 10 designs have more drops dispensed in the horizontal orientation and 12 in the vertical orientation. Six of the 32 bottle designs had a significantly different mean total bottle volume in the vertical and horizontal positions, with all designs having greater volume in the vertical position. An adjusted ratio of mean number of drops/mean bottle volume demonstrated a range from 20.9 drops/mL to 40.8 drops/mL. CONCLUSIONS There is significant variability in drops and volume available per bottle of glaucoma medication depending on both the bottle position and manufacturer. These data point to the need for circumspection in prescribing glaucoma medications and caution in evaluating therapeutic outcomes.
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Affiliation(s)
- Daniel B. Moore
- Department of Ophthalmology and Visual Sciences, University of Kentucky, 740 S. Limestone, Lexington, KY 40536 USA
| | - Judy Beck
- Department of Ophthalmology and Visual Sciences, University of Kentucky, 740 S. Limestone, Lexington, KY 40536 USA
| | - Richard J Kryscio
- Departments of Biostatistics and Statistics, University of Kentucky, Lexington, KY USA
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Beliefs and practices of Greek doctors in relation to patients' adherence to antihypertensive medication. J Hum Hypertens 2016; 31:341-346. [PMID: 28032629 DOI: 10.1038/jhh.2016.84] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 11/02/2016] [Indexed: 11/08/2022]
Abstract
Although it has been proven that decreasing the arterial blood pressure decreases cardiovascular morbidity and mortality, <25% of hypertensive patients receiving antihypertensive treatment achieve target values, which are mainly attributed to failure of the patients to comply to treatment. Ensuring patient compliance to antihypertensive treatment, to prevent the development of hypertension-associated complications, has proven to be challenging in several countries. The aim of the present study was to investigate the knowledge, perceptions and practices applied by doctors treating hypertensive patients regarding patient compliance to the prescribed treatment. We also aimed to assess the possible barriers physicians face to using reinforcement methods and currently available guidelines. A total of 202 doctors from the Serres and Drama prefectures of Greece participated in this study. The data collection comprised a quantitative method questionnaire and the data were processed using Stata 8.0 statistical software. The results demonstrated that 84.7% of the participating doctors do not use the current guidelines for compliance, whereas only 10.1% have consultations lasting >15 min when discussing the medication with their patients. In addition, the majority (84.7%) of the doctors do not practice peer mentoring and consider the most effective interventions to be providing information and discussing the medication with their patients. In conclusion, the level of patient compliance to antihypertensive medication is unsatisfactory and the main reason is considered to be the non-use of guidelines by the treating physicians. Patients may benefit from further education of health professionals in this field.
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Lunnela J, Kääriäinen M, Kyngäs H. Adherence of Finnish people with glaucoma to treatment plans and connected factors. Int J Circumpolar Health 2016; 70:79-89. [DOI: 10.3402/ijch.v70i1.17796] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Adamson E, Kendall G. Difficulty in eye drop administration for people with rheumatoid arthritis. Br J Occup Ther 2016. [DOI: 10.1177/0308022616643101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
IntroductionMany people require eye drops administered daily, yet many do not instil them as prescribed. This can be due to physical difficulty managing the delivery device yet little research has focused on this.MethodsParticipants from ophthalmology and rheumatology clinics at hospitals within two regions in Scotland ( n = 206) were recruited and asked to complete a questionnaire about eye drop use and difficulties they experienced. Binary logistic regression was used to assess the independent relationship between key explanatory variables and the major outcome variable, which was difficulty in administration.FindingsIt was found that 62% of people who attended a rheumatoid arthritis (RA) clinic reported difficulty instilling eye drops and that they were four and a half times more likely to have difficulty than people who attended an ophthalmology clinic. A greater proportion of women and younger people attended the RA clinics than the ophthalmology clinics; however, the reasons given for having difficulty and the level of adherence did not differ between the two groups.ConclusionThe number of people newly diagnosed with RA is increasing worldwide, particularly among women, and many need eye drops. Experiencing difficulty instilling them is therefore a significant international health issue.
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Affiliation(s)
- Elizabeth Adamson
- Associate Professor, School of Nursing Midwifery and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Garth Kendall
- Senior Lecturer, School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia
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Urquhart J, Chevalley C. Impact of Unrecognized Dosing Errors on the Cost and Effectiveness of Pharmaceuticals. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/009286158802200310] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- John Urquhart
- APREX Corporation, Palo Alto, California and Department of Epidemiology, University of Limburg, The Netherlands
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Perri M, Martin BC, Pritchard FL. Improving Medication Compliance: A Practical Intervention. J Pharm Technol 2016. [DOI: 10.1177/875512259501100410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To examine the effect of a device specifically designed to improve patient medication compliance. This device, the Counter Cap (CC), is a prescription vial closure that mechanically indicates when the bottle was last opened, presumably to take a dose of medication. The primary objective was to assess the effect of the CC on patient compliance as measured by refill behavior. Method: An experimental pretest-posttest control group design was used to study the effect of the CC on patient compliance. A systematic sampling technique was used to assign subjects to the experimental and control groups. Patient compliance was assessed through prescription refill behaviors measured over a six-month period (three months pre-CC and three months post-CC). Results: A full six months of prescription refill data were analyzed for 186 of 337 patients from 21 pharmacies. Patients in the experimental group (n = 88) demonstrated significantly improved (F = 4.44, p = 0.0366) medication compliance and less variability in the number of days of departure from the ideal compliance rate (F = 6.89, p = 0.009) over the control group (n = 98) as measured by refill behavior. Conclusions: The CC proved to be an inexpensive means to improve medication compliance as defined by this investigation.
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Kumar JB, Bosworth HB, Sleath B, Woolson S, Olsen M, Danus S, Muir KW. Quantifying Glaucoma Medication Adherence: The Relationship Between Self-Report, Electronic Monitoring, and Pharmacy Refill. J Ocul Pharmacol Ther 2016; 32:346-54. [DOI: 10.1089/jop.2015.0102] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jaya B. Kumar
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Hayden B. Bosworth
- Department of Medicine, Durham VA Medical Center, Duke University School of Medicine, Durham, North Carolina
- Health Services Research & Development, Durham VA Medical Center, Durham, North Carolina
| | - Betsy Sleath
- Eshelman School of Pharmacy, Pharmaceutical Outcomes and Policy, University of North Carolina Chapel Hill, North Carolina
| | - Sandra Woolson
- Health Services Research & Development, Durham VA Medical Center, Durham, North Carolina
| | - Maren Olsen
- Health Services Research & Development, Durham VA Medical Center, Durham, North Carolina
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Susanne Danus
- Health Services Research & Development, Durham VA Medical Center, Durham, North Carolina
| | - Kelly W. Muir
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
- Health Services Research & Development, Durham VA Medical Center, Durham, North Carolina
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Abstract
PURPOSE To develop a prediction model for glaucomatous visual field progression using easily accessible baseline clinical data. PATIENTS AND METHODS We collected baseline data of 613 consecutive patients with open-angle glaucoma from 2001 to 2003. The rate of visual field progression was calculated using the Visual Field Index (VFI) of routine follow-up examinations until 2010. Baseline data of 333 patients from 3 hospitals were used to develop a model to predict the rate of VFI progression using a linear regression analysis and univariate preselection (P<0.1) of 8 candidate predictors. The performance of the model was investigated using R, the area under the receiver-operating characteristic curve, and calibration plots. The prediction model was internally validated using bootstrapping and externally validated in 280 patients from 2 other hospitals. RESULTS After a mean follow-up period of 5.8 years of all 613 eyes, the mean rate of VFI progression was -1.6% per year. The final model contained the following predictors: age, baseline intraocular pressure, and baseline visual field status. During model development, 10.3% of the observed variation in VFI rates was explained by the model. The area under the receiver-operating characteristic curve was 0.76 when the prediction model was used to detect a VFI rate of -3% per year or worse, which decreased to 0.71 at external validation. CONCLUSIONS Although our prediction model could explain only a small amount of the variance in visual field progression, it may offer the possibility to identify subgroups of treated patients with high rates of visual field progression, thereby providing an opportunity to select those patients for more intensive treatment.
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