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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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Ballouz D, Cho J, Woodward MA, Elam AR, Musch DC, Zhang J, Moroi SE, Johnson L, Cederna J, Newman-Casey PA. Facilitators and Barriers to Glaucoma Screening Identified by Key Stakeholders in Underserved Communities: A Community-engaged Research Approach. J Glaucoma 2021; 30:402-409. [PMID: 33273279 PMCID: PMC8084870 DOI: 10.1097/ijg.0000000000001756] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/04/2020] [Indexed: 01/08/2023]
Abstract
PRCIS Community-engaged research (CER) enables researchers to identify community-specific barriers and facilitators to program implementation. Broadly applicable barriers to glaucoma care, such as Cost, Transportation, and Trust, and community-specific barriers, such as Language and Convenience/Access, were identified. PURPOSE The aim was to identify the facilitators and barriers to implementing glaucoma screening programs in 2 community clinics. METHODS A concurrent mixed-methods process analysis using CER. Key stakeholders-including patients, providers, and staff members-from 2 community clinics were interviewed using a semistructured interview guide. Interviews had 2 parts: (1) asking patients about community-based facilitators and barriers to implementing glaucoma screening and care and (2) eliciting feedback about a personalized coaching program. The transcripts were coded using Grounded Theory. Number of participants and number of representative citations were counted per theme. The qualitative analysis was coded using Dedoose 8.3.17 (Los Angeles, CA). RESULTS Thematic saturation was reached after coding 12 interviews. 30 participants were interviewed, 13 from Hamilton Clinic (Flint, MI; 8 patients, 5 providers and staff members) and 17 from Hope Clinic (Ypsilanti, MI; 6 patients, 11 providers and staff members). The most commonly cited themes were: Priorities (98 citations, 30 participants), Knowledge (73, 26) Transportation (63, 26), Cost (60, 23), and Convenience/Access (63, 22). Broadly applicable barriers to glaucoma care, such as Cost, Transportation, and Trust were identified alongside community-specific barriers such as Language and Convenience/Access. Participants rated their likelihood to follow up with an ophthalmologist after participating in the personalized coaching program at a mean of 8.83 (on a scale of 1 to 10 with 10 being the most confident). CONCLUSIONS CER enables researchers to identify community-specific barriers and facilitators, allowing more effective program implementation.
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Affiliation(s)
- Dena Ballouz
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Juno Cho
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Maria A Woodward
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Angela R Elam
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - David C Musch
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Jason Zhang
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Sayoko E Moroi
- Department of Ophthalmology, Ohio State University, Columbus, Ohio
| | | | | | - Paula Anne Newman-Casey
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
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Hollenhorst CN, Elliott V, Heisler M, Schneider K, Resnicow K, Newman-Casey PA. Patient Experience during the Support, Educate, Empower Glaucoma Coaching Program to Improve Medication Adherence: A Pilot Study. Ophthalmol Glaucoma 2020; 3:238-252. [PMID: 33008556 DOI: 10.1016/j.ogla.2020.04.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/21/2020] [Accepted: 04/27/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE To understand patients' qualitative experiences with the Support, Educate, Empower (SEE) personalized glaucoma coaching program, provide a richer understanding of the components of the intervention that were useful in eliciting behavior change, and understand how to improve the SEE Program. DESIGN A concurrent mixed-methods process analysis. PARTICIPANTS Thirty-nine patients with a diagnosis of any kind of glaucoma or ocular hypertension who were aged ≥40 years, were taking ≥1 glaucoma medication, spoke English, self-administered their eye drops, and had poor glaucoma medication adherence (defined as taking ≤80% of prescribed medication doses assessed via electronic medication adherence monitors) who completed the 7-month SEE Program. METHODS All participants who completed the study were interviewed in-person using a semistructured interview guide after the intervention. Coders conducted qualitative analysis of transcribed interviews using Grounded Theory. Participants were then stratified into groups based on change in adherence, and thematic differences between groups were examined. MAIN OUTCOME MEASURES Themes that emerged from interviews categorized by the number of participants who expressed a theme and the number of representative citations. RESULTS Participants expressed positive views toward the program overall (95%, n = 37/39). They perceived program components as working together to improve their medication adherence. Interactions with the glaucoma coach (38 participants, 184 citations), motivation to aid personal change (38 participants, 157 citations), personalized glaucoma education (38 participants, 149 citations), electronic reminders, and hearing their adherence score (37 participants, 90 citations) were most commonly cited by participants as helpful program elements contributing to improved adherence. Patients expressed a desire for personalized education to be a standard part of glaucoma care. Participants who demonstrated more improvement in adherence had a more trusting attitude toward the adherence score and a greater magnitude of perceived personal need to improve adherence. CONCLUSIONS Participants reported a highly positive response to the in-person glaucoma education and motivational interviewing intervention used in conjunction with automated adherence reminders.
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Affiliation(s)
- Cecilia N Hollenhorst
- Department of Ophthalmology & Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | | | - Michele Heisler
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan; Department of Health Behavior Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Kevin Schneider
- Department of Ophthalmology & Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Ken Resnicow
- Department of Health Behavior Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Paula Anne Newman-Casey
- Department of Ophthalmology & Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan.
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Fiscella R, Caplan E, Kamble P, Bunniran S, Uribe C, Chandwani H. The Effect of an Educational Intervention on Adherence to Intraocular Pressure-Lowering Medications in a Large Cohort of Older Adults with Glaucoma. J Manag Care Spec Pharm 2018; 24:1284-1294. [PMID: 29848186 PMCID: PMC10397933 DOI: 10.18553/jmcp.2018.17465] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Glaucoma is a progressive, irreversible disease that can lead to vision loss and lower quality of life if treatment is not optimized. Effective glaucoma therapies are available to lower intraocular pressure (IOP) and minimize or delay disease progression. Nonetheless, adherence to treatment remains suboptimal for many patients. OBJECTIVE To identify potentially nonadherent patients and evaluate the effect of patient- and physician-centric educational interventions on adherence by using a validated predictive model of nonadherence to glaucoma medication. METHODS This prospective, randomized, controlled, and interventional study included Humana Medicare Advantage Prescription Drug plan patients with a glaucoma diagnosis between May and October 2014, ≥ 1 pharmacy claim for glaucoma medication, and ≥ 50% likelihood of nonadherence. Patients and physicians were randomized to cohorts A (no interventions), B (physician intervention), or C (patient and physician interventions). Physicians in cohorts B and C received information on the model, adherence, and patient profiles at baseline and months 3, 6, and 9. Patients in cohort C received educational materials on glaucoma and adherence (same schedule). The primary outcome was the proportion of days covered (PDC) with medication over 12 months. Adherence was defined as PDC ≥ 0.80. RESULTS Overall, 23,306 patients and 2,955 physicians were eligible. After excluding physicians with < 3 nonadherent patients, each cohort included 200 physicians and 600 patients. Mean PDC was 0.54-0.56 across cohorts. At 12 months, ≥ 90.5% of physicians and ≥ 75.5% of patients remained in the study; mean PDC was 0.53-0.54 across cohorts. No statistically significant between-cohort differences in PDC and adherence were observed. CONCLUSIONS Intensive educational mailings to patients and their physicians did not improve PDC or adherence in this large population of potentially nonadherent patients with glaucoma. Findings highlight the difficulty of improving adherence in a disease that requires lifelong therapy despite being largely asymptomatic and can inform development of future interventions aimed at improving adherence to glaucoma therapy. DISCLOSURES This study was sponsored by Allergan plc (Dublin, Ireland). Fiscella and Chandwani are employees of Allergan plc. Caplan, Kamble, Bunniran, and Uribe are employees of Comprehensive Health Insights, a Humana company. The authors did not receive honoraria or other payments for authorship.
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Newman-Casey PA, Dayno M, Robin AL. Systematic Review of Educational Interventions to Improve Glaucoma Medication Adherence: an update in 2015. EXPERT REVIEW OF OPHTHALMOLOGY 2016; 11:5-20. [PMID: 27134639 DOI: 10.1586/17469899.2016.1134318] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE To evaluate the current state of the research on educational interventions whose aim is to improve glaucoma medication adherence. METHODS A systematic review of Pubmed, Embase and CINAHL was conducted to identify research studies evaluating educational interventions to improve glaucoma medication adherence. Studies were included if the intervention was described, the outcomes assessed glaucoma medication adherence, and the focus of the research was on adults with glaucoma. The search was conducted on June 2, 2015. RESULTS Seventeen studies were identified that met the inclusion criteria. These included nine randomized controlled trials and eight observational studies. Eight of the studies demonstrated an impact on glaucoma medication adherence, though their outcome measures were too heterogeneous to estimate a pooled effect size.. CONCLUSION The interventions that successfully improved glaucoma medication adherence used an adequate dose of face-to-face counseling to overcome barriers to health behavior change alongside education about glaucoma.
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Affiliation(s)
- Paula Anne Newman-Casey
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA; Department of Ophthalmology, University of Maryland, Baltimore, MD, USA; Departments of Ophthalmology & International Health, Johns Hopkins University, Baltimore, MD
| | - Megan Dayno
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Alan L Robin
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
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Cate H, Bhattacharya D, Clark A, Fordham R, Notley C, Broadway DC. Protocol for a randomised controlled trial to estimate the effects and costs of a patient centred educational intervention in glaucoma management. BMC Ophthalmol 2012; 12:57. [PMID: 23171166 PMCID: PMC3536708 DOI: 10.1186/1471-2415-12-57] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 11/12/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Poor glaucoma education is thought to be a causative factor of non-adherence to glaucoma therapy. However, the multi-factorial nature of non-adherent behaviour may explain the failure of purely educational interventions to achieve significant improvement in adherence. Behaviour Change Counselling (BCC) allows both the imparting of information and assessment of patient ambivalence to medication use and may elicit behaviour change in order to achieve better adherence. The chronic and complex nature of glaucoma means that patient non-adherence to glaucoma therapy does not easily correlate with measureable objective clinical endpoints. However, electronic medication monitoring offers an objective method of measuring adherence without reliance on clinical endpoints. METHODS/DESIGN The study is a randomised controlled trial (RCT) with glaucoma (open angle) or ocular hypertension patients attending a glaucoma clinic and prescribed travoprost. The study will determine whether additional glaucoma education using BCC is beneficial and cost effective in improving adherence with glaucoma therapy. An 8-month follow-up period, using an electronic adherence monitoring device (Travalert dosing aid, TDA), will indicate if the intervention is likely to be sustained in the longer term. Additionally, a cost-effectiveness framework will be used to estimate the cost benefit of improving adherence. The development of a novel intervention to deliver glaucoma education using BCC required practitioner training and fidelity testing. Five practitioners were successfully trained to become Glaucoma Support Assistants able to deliver the BCC intervention. The research group had prior clinical and investigative experience in this setting, and used multiple strategies to design a method to address the study objectives. DISCUSSION This RCT, using BCC to improve adherence to ocular hypotensive therapy, to our knowledge is the first within this disease area. Using a variety of adherence measures allows examination of the known inaccuracies of patient self-report with respect to glaucoma medication. The novel BCC component has undergone fidelity testing using BECCI and the BCC template will ensure conformity to a standardised intervention. TRIAL REGISTRATION Current Controlled Trials: ISRCTN89683704.
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Affiliation(s)
- Heidi Cate
- Ophthalmology, Norfolk & Norwich University Hospital NHS Foundation Trust, Colney Lane, Norwich NR4 7UY, UK.
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