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Abid A, Baxter SL. Breaking Barriers in Behavioral Change: The Potential of Artificial Intelligence-Driven Motivational Interviewing. J Glaucoma 2024; 33:473-477. [PMID: 38595151 DOI: 10.1097/ijg.0000000000002382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 03/16/2024] [Indexed: 04/11/2024]
Abstract
Patient outcomes in ophthalmology are greatly influenced by adherence and patient participation, which can be particularly challenging in diseases like glaucoma, where medication regimens can be complex. A well-studied and evidence-based intervention for behavioral change is motivational interviewing (MI), a collaborative and patient-centered counseling approach that has been shown to improve medication adherence in glaucoma patients. However, there are many barriers to clinicians being able to provide motivational interviewing in-office, including short visit durations within high-volume ophthalmology clinics and inadequate billing structures for counseling. Recently, Large Language Models (LLMs), a type of artificial intelligence, have advanced such that they can follow instructions and carry coherent conversations, offering novel solutions to a wide range of clinical problems. In this paper, we discuss the potential of LLMs to provide chatbot-driven MI to improve adherence in glaucoma patients and provide an example conversation as a proof of concept. We discuss the advantages of AI-driven MI, such as demonstrated effectiveness, scalability, and accessibility. We also explore the risks and limitations, including issues of safety and privacy, as well as the factual inaccuracies and hallucinations to which LLMs are susceptible. Domain-specific training may be needed to ensure the accuracy and completeness of information provided in subspecialty areas such as glaucoma. Despite the current limitations, AI-driven motivational interviewing has the potential to offer significant improvements in adherence and should be further explored to maximally leverage the potential of artificial intelligence for our patients.
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Affiliation(s)
- Areeba Abid
- Emory University School of Medicine, Atlanta, GA
| | - Sally L Baxter
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego
- Divison of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, CA
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Bott D, Subramanian A, Edgar D, Lawrenson JG, Campbell P. Barriers and enablers to medication adherence in glaucoma: A systematic review of modifiable factors using the Theoretical Domains Framework. Ophthalmic Physiol Opt 2024; 44:96-114. [PMID: 37985237 DOI: 10.1111/opo.13245] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 11/22/2023]
Abstract
PURPOSE Nonadherence to medication reduces treatment effectiveness, and in chronic conditions it can significantly reduce health outcomes. In glaucoma, suboptimal adherence can lead to sight loss, which places a greater financial burden on society and reduces patients' quality of life. Interventions to improve adherence have so far had limited success and lack robust theoretical underpinnings. A better understanding of the determinants of medication adherence behaviour is needed in order to develop interventions that can target these factors more effectively. This systematic review aims to identify modifiable barriers and enablers to glaucoma medication adherence and identify factors most likely to influence adherence behaviour. RECENT FINDINGS We searched CINAHL, MEDLINE, PsycINFO, EMBASE, the Cochrane Library and sources of grey literature up to August 2022 for studies reporting determinants of glaucoma medication adherence. Data describing modifiable barriers/enablers to adherence were extracted and analysed using the Theoretical Domains Framework (TDF), a behavioural framework consisting of 14 domains representing theoretical factors that most likely influence behaviour. Data were deductively coded into one of the TDF domains and inductively analysed to generate themes. Key behavioural domains influencing medication adherence were identified by frequency of study coding, level of elaboration and expressed importance. Eighty-three studies were included in the final synthesis. Four key domains influencing glaucoma medication adherence were identified: 'Environmental Context and Resources', 'Knowledge', 'Skills' and 'Memory, Attention and decision processes'. Frequently reported barriers included complex eyedrop regimens, lack of patient understanding of their condition, forgetfulness and difficulties administering eyedrops. Whereas simplified treatments, knowledgeable educated patients and good patient-practitioner relationships were enablers to adherence. SUMMARY We identified multiple barriers and enablers affecting glaucoma medication adherence. Four theoretical domains were found to be key in influencing adherence behaviour. These findings can be used to underpin the development of behaviour change interventions that aim to improve medication adherence.
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Affiliation(s)
- Deborah Bott
- Department of Optometry and Visual Sciences, School of Health and Psychological Sciences, City, University of London, London, UK
| | - Ahalya Subramanian
- Department of Optometry and Visual Sciences, School of Health and Psychological Sciences, City, University of London, London, UK
| | - David Edgar
- Department of Optometry and Visual Sciences, School of Health and Psychological Sciences, City, University of London, London, UK
| | - John G Lawrenson
- Department of Optometry and Visual Sciences, School of Health and Psychological Sciences, City, University of London, London, UK
| | - Peter Campbell
- Department of Optometry and Visual Sciences, School of Health and Psychological Sciences, City, University of London, London, UK
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Stingl JV, Greslechner R, Brandl C, Heid IM, Hoffmann EM, Pfeiffer N, Schuster AK. [Awareness for glaucoma in the general population]. DIE OPHTHALMOLOGIE 2023; 120:1088-1097. [PMID: 37847376 DOI: 10.1007/s00347-023-01943-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Glaucoma is not a rare entity but because very few symptoms occur and visual field defects are frequently first recognized at a late stage, a large proportion of glaucoma diseases remain undetected. The aim of this study was to identify the proportion of undiagnosed glaucoma in German population-based cohort studies and to contextualize them in the context of the literature. MATERIAL AND METHODS The prevalence of glaucoma in the Gutenberg Health Study (GHS) and the age-related investigations on health of the University of Regensburg (AugUR) was evaluated based on visual field examinations and optic disc color photography according to the ISGEO criteria. Furthermore, the self-reported glaucoma diagnoses were collected and the proportion of undiagnosed glaucoma was determined. RESULTS The proportion of undiagnosed glaucoma was 55% in the GHS, and 53% in the AugUR study. The results correlate with results from previous studies from other countries in which the proportion of unrecognized glaucoma ranged from 33% to 78%. In the GHS and the AugUR study the proportion of undiagnosed glaucoma was higher in younger age groups and in women. DISCUSSION Roughly every second case of glaucoma is undetected. As the symptoms are often nonspecific or take a long time to appear, there is a risk of advanced glaucomatous visual field defects or blindness due to a lack of glaucoma awareness. Studies have shown that a systematic screening can halve this risk.
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Affiliation(s)
- Julia V Stingl
- Augenklinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.
| | - R Greslechner
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Caroline Brandl
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Regensburg, Deutschland
- Lehrstuhl für Genetische Epidemiologie, Universität Regensburg, Regensburg, Deutschland
| | - Iris M Heid
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Esther M Hoffmann
- Augenklinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - Norbert Pfeiffer
- Augenklinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - Alexander K Schuster
- Augenklinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
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Cho J, Song M, Niziol LM, Heisler M, Resnicow K, Musch DC, Lee P, Da rnley-Fisch D, Newman-Casey PA. Patient-Centered Outcomes After a Medication Adherence Intervention: a Pilot Study. J Glaucoma 2023; 32:891-899. [PMID: 37054438 PMCID: PMC10544696 DOI: 10.1097/ijg.0000000000002228] [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: 11/07/2022] [Accepted: 03/14/2023] [Indexed: 04/15/2023]
Abstract
PRCIS Self-determination theory (SDT) guided behavioral interventions are effective in improving several patient-centered metrics, including glaucoma-related distress. However, whether improvement in patient-centered metrics can drive an improvement in medication-taking behavior remains to be seen. OBJECTIVE The 7-month Support, Educate, Empower (SEE) personalized glaucoma coaching program was previously shown to improve glaucoma medication adherence by 21 percent points. This study's goal was to assess the impact of the SEE program on self-determination theory (SDT) metrics and other patient-centered outcome measures. PARTICIPANTS AND METHODS Glaucoma patients (≥40 y old, taking ≥1 medication) self-reporting poor medication adherence were recruited at the University of Michigan. Eight surveys (with 10 subscales) were completed before and after the 7-month SEE program. Three surveys assessed changes in SDT (Treatment Self-regulation Questionnaire, Healthcare-Climate Questionnaire, Perceived Competence) while the others assessed participants' Glaucoma Knowledge, Glaucoma Medication Self-efficacy, Glaucoma-related distress, Perceived benefits, confidence asking and getting questions answered. RESULTS Thirty-nine participants completed the SEE program. Significant improvements were in 7 subscales, including all three SDT tenets of competence (mean change =0.9, SD =±1.2, adjusted P =0.0002), autonomy (0.5, ±0.9, 0.044), and relatedness ( P =0.002). Glaucoma-related distress (-2.0, ±3.2, 0.004), confidence in asking questions (1.1, ±2.0, 0.008), and confidence in getting questions answered (1.0, ±2.0, 0.009) also improved. Glaucoma-related distress was correlated with perceived competence ( r =-0.56, adjusted P =0.005), and an increase in perceived competence was associated with a decrease in glaucoma-related distress (β=-0.43, 95% CI -0.67 - -0.20, adjusted P =0.007). CONCLUSIONS The SEE program improved participants' autonomous motivation, perceived support, perceived competence, glaucoma-related distress, and competence. These results point to the promising potential of SDT-guided behavioral interventions in improving patient-centered metrics.
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Affiliation(s)
- Juno Cho
- Department of Ophthalmology & Visual Sciences, University of Michigan Medical School, Ann Arbor, MI
| | - Melinda Song
- Department of Ophthalmology & Visual Sciences, University of Michigan Medical School, Ann Arbor, MI
| | - Leslie M. Niziol
- Department of Ophthalmology & Visual Sciences, University of Michigan Medical School, Ann Arbor, MI
| | - Michele Heisler
- Institute for Health Policy and Innovation, University of Mich igan, Ann Arbor, MI
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Ken Resnicow
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI
| | - David C. Musch
- Department of Ophthalmology & Visual Sciences, University of Michigan Medical School, Ann Arbor, MI
- Institute for Health Policy and Innovation, University of Mich igan, Ann Arbor, MI
| | - Paul Lee
- Department of Ophthalmology & Visual Sciences, University of Michigan Medical School, Ann Arbor, MI
- Institute for Health Policy and Innovation, University of Mich igan, Ann Arbor, MI
| | | | - Paula Anne Newman-Casey
- Department of Ophthalmology & Visual Sciences, University of Michigan Medical School, Ann Arbor, MI
- Institute for Health Policy and Innovation, University of Mich igan, Ann Arbor, MI
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Hwang IC, Suh HS, Choi S. Factors Associated with Non-Adherence to Glaucoma Treatment in a Korean Nationwide Survey. IRANIAN JOURNAL OF PUBLIC HEALTH 2022; 51:1259-1264. [PMID: 36447979 PMCID: PMC9659527 DOI: 10.18502/ijph.v51i6.9669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/10/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND Glaucoma is a main cause of blindness despite the effectiveness of treatments, and adherence to treatment is a critical aspect of glaucoma management. We aimed to identify the factors associated with non-adherence to treatment among Korean glaucoma patients. METHODS Data were collected from 4,833 glaucoma patients during the Korea Community Health Survey (KCHS) in 2008 and 2011 regarding current treatment for glaucoma, demographics, comorbidities, perceived health status, and health-related behaviors were subjected to analysis. A multivariable regression model was applied to identify factors related to non-treatment for glaucoma. RESULTS Approximately, half of the 4,883 patients failed to adhere to treatment. Compared to the treatment group, the non-treatment group had lower social status, fewer comorbid conditions, were more optimistic about their health statuses, and more likely to adopt unhealthy behaviors. Stepwise regression analysis showed that poor social status (low level of education and unmarried), self-perception of a satisfactory health status, and unhealthy behaviors (smoking and no flu-vaccination) were significantly associated with non-adherent to treatment. CONCLUSION More attention should be paid to glaucoma patients with low social status or that are overconfident about their health. Future prospective studies that more comprehensively assess treatment compliance, are needed to confirm our findings.
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Affiliation(s)
- In Cheol Hwang
- Department of Family Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Heuy Sun Suh
- Department of Family Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Seulggie Choi
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
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Chow SC, Lam PY, Choy BNK. Patient-centred care in ophthalmology: current practices, effectiveness and challenges. Graefes Arch Clin Exp Ophthalmol 2022; 260:3149-3159. [PMID: 35445876 DOI: 10.1007/s00417-022-05666-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/16/2022] [Accepted: 04/08/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To summarise different patient-centred care approaches that can be used in ophthalmology and review their effectiveness. METHODS An Entrez Pubmed search on publications concerning different patient-centred care was performed on September 7, 2021. Articles on animal research, non-English language and review articles were excluded after manually screening by two authors. RESULTS A total of 16 articles were reviewed after curation by the authors for relevance. Patient-centred care has advantages in improving disease knowledge, enhancing doctor-patient communications and improving mental well-being of patients. Various methods including intensive patient education, patient-centred communication techniques during consultations, personal disease records, education programme for caregivers, on-site ocular care for residential care home resident and shared medical appointments can be used to enhance patient-centred care. CONCLUSIONS Current strategies in patient-centred care in ophthalmology were found to be useful. However, they have not been widely practised and more studies would be required generate an evidence-based recommendation for future use.
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Affiliation(s)
- Shing Chuen Chow
- LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Pun Yuet Lam
- LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Bonnie Nga Kwan Choy
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Room 301, Block B, Cyberport 4, Cyberport, Hong Kong, Hong Kong.
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Parwati NM, Bakta IM, Januraga PP, Wirawan IMA. A Health Belief Model-Based Motivational Interviewing for Medication Adherence and Treatment Success in Pulmonary Tuberculosis Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413238. [PMID: 34948846 PMCID: PMC8701142 DOI: 10.3390/ijerph182413238] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 11/16/2022]
Abstract
Medication adherence behavior plays a central role in the success of tuberculosis (TB) treatment. Conventional motivation is not optimal in strengthening long-term medication adherence. A motivational interviewing (MI) communication motivation model based on the Health Belief Model (HBM) was designed with the main objective of improving medication adherence and treatment success. This study used an experimental design with a randomized posttest-only control group design. The intervention and control groups consisted of 107 TB patients each, who were selected by random cluster sampling. The study was conducted from November 2020 to June 2021 at 38 public health centers in Bali Province. The HBM-based MI model intervention was given in seven counseling sessions, pill count percentages were used to measure medication adherence, and treatment success was based on sputum examination results. Logistic regression was used to assess the effect of the intervention on medication adherence and treatment success. Logistic regression analysis showed that MI-based HBM and knowledge were the most influential variables for increasing medication adherence and treatment success. Medication adherence was 4.5 times greater (ARR = 4.51, p = 0.018) and treatment success was 3.8 times greater (ARR = 3.81, p < 0.038) in the intervention group compared to the control group, while the secondary outcome of knowledge of other factors together influenced medication adherence and treatment success. The conclusion is that the HBM-based MI communication motivation model creates a patient-centered relationship by overcoming the triggers of treatment barriers originating from the HBM construct, effectively increasing medication adherence and treatment success for TB patients, and it needs further development by involving families in counseling for consistent self-efficacy of patients in long-term treatment.
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Affiliation(s)
- Ni Made Parwati
- Doctoral Study Program, Medical Faculty, Udayana University, Denpasar 80361, Indonesia
- Correspondence:
| | - I Made Bakta
- Department of Internal Medicine, Medical Faculty, Udayana University, Denpasar 80234, Indonesia;
| | - Pande Putu Januraga
- School of Public Health, Udayana University, Denpasar 80234, Indonesia; (P.P.J.); (I.M.A.W.)
| | - I Made Ady Wirawan
- School of Public Health, Udayana University, Denpasar 80234, Indonesia; (P.P.J.); (I.M.A.W.)
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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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Al Owaifeer AM, Alrefaie SM, Alsawah ZM, Al Taisan AA, Mousa A, Ahmad SI. The effect of a short animated educational video on knowledge among glaucoma patients. Clin Ophthalmol 2018; 12:805-810. [PMID: 29750013 PMCID: PMC5936007 DOI: 10.2147/opth.s160684] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Purpose To evaluate the effectiveness of an educational video in increasing knowledge among glaucoma patients and to determine the factors that may influence a patient’s level of knowledge. Patients and methods This was a pre–post intervention study on adult glaucoma patients attending the outpatient service at King Khaled Eye Specialist Hospital. The intervention tested was a short educational video that was edited specifically for this study. All patients completed a pre-video and post-video knowledge questionnaire; moreover, sociodemographic and clinical characteristics were obtained. Results The total number of patients included was 196. The mean age of patients was 55.7±15.5 years. Overall, 55.1% were males, 29.6% were illiterate, 85.2% resided in an urban area, 62.8% had a low income, and 41.8% were unemployed. The mean pre-intervention knowledge score was 6 out of 17, and the post-intervention score was 11.1 (P≤0.001). Predictors of a poor knowledge score were old age (>60 years), female sex, illiteracy, rural residence, low income, unemployment, and a negative family history of glaucoma. Conclusion The evaluated video intervention was effective in a short-term increase in knowledge among glaucoma patients. This tool may serve as an alternative to traditional educational methods.
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Affiliation(s)
- Adi Mohammed Al Owaifeer
- Faculty of Ophthalmology, College of Medicine, King Faisal University, Al-Hasa, Saudi Arabia.,King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | | | | | | | - Ahmed Mousa
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Sameer I Ahmad
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA.,Glaucoma Consultants of Washington, Herndon, VA, USA
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Cook PF, Schmiege SJ, Mansberger SL, Sheppler C, Kammer J, Fitzgerald T, Kahook MY. Motivational interviewing or reminders for glaucoma medication adherence: Results of a multi-site randomised controlled trial. Psychol Health 2016; 32:145-165. [PMID: 27701902 DOI: 10.1080/08870446.2016.1244537] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Nonadherence reduces glaucoma treatment efficacy. Motivational interviewing (MI) is a well-studied adherence intervention, but has not been tested in glaucoma. Reminder interventions also may improve adherence. DESIGN 201 patients with glaucoma or ocular hypertension were urn-randomised to receive MI delivered by an ophthalmic technician (OT), usual care or a minimal behavioural intervention (reminder calls). MAIN OUTCOME MEASURES Outcomes included electronic monitoring with Medication Event Monitoring System (MEMS) bottles, two self-report adherence measures, patient satisfaction and clinical outcomes. Multilevel modelling was used to test differences in MEMS results by group over time; ANCOVA was used to compare groups on other measures. RESULTS Reminder calls increased adherence compared to usual care based on MEMS, p = .005, and self-report, p = .04. MI had a nonsignificant effect but produced higher satisfaction than reminder calls, p = .007. Treatment fidelity was high on most measures, with observable differences in behaviour between groups. All groups had high baseline adherence that limited opportunities for change. CONCLUSION Reminder calls, but not MI, led to better adherence than usual care. Although a large literature supports MI, reminder calls might be a cost-effective intervention for patients with high baseline adherence. Replication is needed with less adherent participants.
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Affiliation(s)
- Paul F Cook
- a College of Nursing , University of Colorado , Aurora , CO , USA
| | - Sarah J Schmiege
- a College of Nursing , University of Colorado , Aurora , CO , USA
| | | | | | - Jeffrey Kammer
- c Vanderbilt Eye Institute , Vanderbilt University , Nashville , TN , USA
| | - Timothy Fitzgerald
- d Global Health Outcomes , Merck & Co. Inc. , White Horse Station , NJ , USA
| | - Malik Y Kahook
- e School of Medicine , University of Colorado , Aurora , CO , USA
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Abstract
Allergen immunotherapy (AIT) can improve allergic response by modifying the underlying disease. Many patients are nonadherent, and do not achieve full benefit. Numerous studies reveal that fewer than 10% of patients complete a full course and that most abandon treatment in the first year. The development and testing of interventions to improve AIT are emerging. Data from adherence interventions in other chronic conditions provide guidance to allergists/immunologists. Evidence-based communication strategies-patient-centered care, motivational interviewing, and shared-decision making-underscore the importance of taking time to establish trust, understand patient concerns and priorities, and involve the patient in decisions regarding AIT.
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12
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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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Conn VS, Ruppar TM, Enriquez M, Cooper P. Medication adherence interventions that target subjects with adherence problems: Systematic review and meta-analysis. Res Social Adm Pharm 2016; 12:218-46. [PMID: 26164400 PMCID: PMC4679728 DOI: 10.1016/j.sapharm.2015.06.001] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 06/06/2015] [Accepted: 06/06/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND Inadequate medication adherence is a pervasive, under-recognized cause of poor health outcomes. Many intervention trials designed to improve medication adherence have targeted adults with adherence problems. No previous reviews have synthesized the effectiveness of medication adherence interventions focused on subjects with medication adherence difficulties. OBJECTIVE This systematic review and meta-analysis synthesized findings from medication adherence intervention studies conducted among adults with medication adherence difficulties. METHODS Primary research studies were eligible for inclusion if they tested an intervention designed to increase medication adherence among adults with documented adherence difficulties and reported medication adherence behavior outcomes. Comprehensive search strategies of 13 computerized databases, author and ancestry searches, and hand searches of 57 journals were used to locate eligible primary research. Participant demographics, intervention characteristics, and methodological features were reliably coded from reports along with medication adherence outcomes. Effect sizes for outcomes were calculated as standardized mean differences, and random effects models were used to estimate overall mean effects. Exploratory dichotomous and continuous variable moderator analyses were employed to examine potential associations between medication adherence effect size and sample, intervention, and methodological characteristics. RESULTS Data were extracted from 53 reports of studies involving 8243 individual primary study participants. The overall standardized mean difference effect size for treatment vs. control subjects was 0.301. For treatment pre- vs. post-intervention comparisons, the overall effect size was 0.533. Significantly larger effect sizes were associated with interventions incorporating prompts to take medications than interventions lacking medication prompts (0.497 vs. 0.234). Larger effect sizes were also found for interventions that linked medication taking with existing habits compared to interventions that did not (0.574 vs. 0.222). Effect sizes were largest among studies that measured adherence by pill counts or electronic event monitoring systems. Analysis of study design features identified several potential risks of bias. Statistically significant publication bias was detected, but adherence effect sizes were not significantly associated with other risks of bias. CONCLUSIONS These findings document that interventions targeting individuals with medication adherence problems can have modest but significant effects on medication-taking behavior. The findings support the use of behavioral strategies such as prompts and linking medications to habits to increase medication adherence in adults with adherence challenges. Face-to-face interventions appear to be critical for patients who have experienced past problems with medication adherence.
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Affiliation(s)
- Vicki S. Conn
- Sinclair School of Nursing; University of Missouri; Columbia, MO 65211; USA
| | - Todd M. Ruppar
- Sinclair School of Nursing; University of Missouri; Columbia, MO 65211; USA
| | - Maithe Enriquez
- Sinclair School of Nursing; University of Missouri; Columbia, MO 65211; USA
| | - Pam Cooper
- Sinclair School of Nursing; University of Missouri; Columbia, MO 65211; USA
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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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Abstract
BACKGROUND Poor adherence hinders glaucoma treatment. Studies have identified demographic and clinical predictors of adherence but fewer psychological variables. PURPOSE We examined predictors from four health behavior theories and past research. METHODS In the baseline phase of a three-site adherence study, before any intervention, 201 participants used electronic Medication Event Monitoring System (MEMS) bottles to monitor eyedrop use for 2 months, and completed questionnaires including self-reported adherence. RESULTS MEMS showed 79% adherence and self-report 94% (0.5-1.5 missed weekly doses), but they correlated only r(s) = 0.31. Self-efficacy, motivation, dose frequency, and nonminority race/ethnicity predicted 35% of variance in MEMS. Cues to action, self-efficacy, and intention predicted 20% of variance in self-reported adherence. CONCLUSIONS Self-efficacy, motivation, intention, cues to action, dose frequency, and race/ethnicity each independently predicted adherence. Predictors from all theories were supported in bivariate analyses, but additional study is needed. Researchers and clinicians should consider psychological predictors of adherence. (ClinicalTrials.gov ID# NCT01409421.).
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Vin A, Schneider S, Muir KW, Rosdahl JA. Health coaching for glaucoma care: a pilot study using mixed methods. Clin Ophthalmol 2015; 9:1931-43. [PMID: 26604666 PMCID: PMC4629983 DOI: 10.2147/opth.s92935] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Introduction Adherence to glaucoma medications is essential for successful treatment of the disease but is complex and difficult for many of our patients. Health coaching has been used successfully in the treatment of other chronic diseases. This pilot study explores the use of health coaching for glaucoma care. Methods A mixed methods study design was used to assess the health coaching intervention for glaucoma patients. The health coaching intervention consisted of four to six health coaching sessions with a certified health coach via telephone. Quantitative measures included demographic and health information, adherence to glaucoma medications (using the visual analog adherence scale and medication event monitoring system), and an exit survey rating the experience. Qualitative measures included a precoaching health questionnaire, notes made by the coach during the intervention, and an exit interview with the subjects at the end of the study. Results Four glaucoma patients participated in the study; all derived benefits from the health coaching. Study subjects demonstrated increased glaucoma drop adherence in response to the coaching intervention, in both visual analog scale and medication event monitoring system. Study subjects’ qualitative feedback reflected a perceived improvement in both eye and general health self-care. The subjects stated that they would recommend health coaching to friends or family members. Conclusion Health coaching was helpful to the glaucoma patients in this study; it has the potential to improve glaucoma care and overall health.
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Affiliation(s)
- Anita Vin
- Department of Ophthalmology, Duke University, Durham, NC, USA
| | - Suzanne Schneider
- Department of Health Philosophy and Promotion, Maryland University of Integrative Health, Laurel, MD, USA
| | - Kelly W Muir
- Department of Ophthalmology, Duke University, Durham, NC, USA ; Durham VA Medical Center, Durham, NC, USA
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Patterns of Glaucoma Medication Adherence over Four Years of Follow-Up. Ophthalmology 2015; 122:2010-21. [PMID: 26319441 DOI: 10.1016/j.ophtha.2015.06.039] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 06/04/2015] [Accepted: 06/20/2015] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To assess longer-term patterns of glaucoma medication adherence and identify whether patterns established during the first year of medication use persist during 3 subsequent years of follow-up. DESIGN Retrospective, longitudinal cohort analysis. PARTICIPANTS Beneficiaries aged ≥40 years who were enrolled in a United States (US)-managed care plan for ≥7 years between 2001 and 2012 and newly diagnosed and treated for open-angle glaucoma. METHODS For each enrollee, we quantified medication adherence using the medication possession ratio. Group-based trajectory modeling (GBTM) was applied to identify patterns of adherence for 1 and 4 years of follow-up. The percent of beneficiaries who remained in the same trajectory group in the 1- and 4-year models was tabulated to evaluate group stability. Factors impacting adherence at 1 and 4 years were identified using regression analyses. MAIN OUTCOME MEASURES Patterns of glaucoma medication adherence. RESULTS Of the 1234 eligible beneficiaries, GBTM identified 5 distinct glaucoma medication adherence patterns in both the 1-year and 4-year follow-up periods. These groups were as follows: (1) never adherent after their index prescription fill (7.5% and 15.6% of persons in the 1- and 4-year models, respectively); (2) persistently very poor adherence (14.9% and 23.4% of persons in the 1- and 4-year models, respectively); (3) declining adherence (9.5% and 9.1% of persons in the 1- and 4-year models, respectively); (4) persistently moderate adherence (48.1% and 37.0% of persons in the 1- and 4-year models, respectively); and (5) persistently good adherence (20.0% and 15.0% of persons in the 1- and 4-year models, respectively). More than 90% of beneficiaries in the 4 groups with the worst and best adherence patterns (groups 1, 2, 3, 5) maintained their patterns from their first year throughout their 4 years of follow-up. Those with persistently moderate adherence (group 4), the largest group, were most likely to change groups from 1 to 4 years of follow-up. Persons with the best adherence over 4 years were more likely to be white, to be older, to earn >$60 000/year, and to have more eye care visits (P < 0.05 for all comparisons). Those with a higher initial copayment cost had lower adherence rates (β = -0.06/dollar, P = 0.03). CONCLUSIONS For most patients who were newly prescribed glaucoma medications, adherence patterns observed in the first year of treatment reflect adherence patterns over the subsequent 3 years. Investing resources in both identifying and helping patients with suboptimal adherence patterns over the first year may have a large impact on longer-term adherence.
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Abstract
Patient nonadherence significantly burdens the treatment of allergic rhinitis (AR). Fewer than half of prescribed doses of intranasal corticosteroid medication are taken. The challenges for immunotherapies are even greater. While sustained treatment for 3 to 5 years is required for full benefit, most patients receiving immunotherapy, either subcutaneous or sublingual, stop treatment within the first year. Although research into interventions to improve AR adherence is lacking, lessons learned from adherence interventions in other chronic health conditions can be applied to AR. Two well-established, overriding models of care-the chronic care model and patient-centered care-can improve adherence. The patient-centered care model includes important lessons for allergy providers in their daily practice, including understanding and targeting modifiable barriers to adherence. Additionally, recent studies have begun to leverage health information and communication technologies to reach out to patients and promote adherence, extending patient-centered interventions initiated by providers during office visits.
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Affiliation(s)
- Bruce G Bender
- Department of Pediatrics, National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA,
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Newman-Casey PA, Robin AL, Blachley T, Farris K, Heisler M, Resnicow K, Lee PP. The Most Common Barriers to Glaucoma Medication Adherence: A Cross-Sectional Survey. Ophthalmology 2015; 122:1308-16. [PMID: 25912144 DOI: 10.1016/j.ophtha.2015.03.026] [Citation(s) in RCA: 294] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 03/16/2015] [Accepted: 03/23/2015] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To evaluate the frequency of 11 commonly cited barriers to optimal glaucoma medication adherence among glaucoma patients and to identify barriers contributing to poor adherence. DESIGN Prospective, cross-sectional survey. PARTICIPANTS One hundred ninety adults with glaucoma taking 1 or more glaucoma medication who received care in glaucoma clinics in Ann Arbor, Michigan, and Baltimore, Maryland. METHODS Participants completed a survey on demographic and disease characteristics, barriers to optimal glaucoma medication adherence, interest in an eye drop aid, and self-reported adherence (measured by the Morisky Adherence Scale). Descriptive statistics and logistic regression analyses were performed. MAIN OUTCOME MEASURES Frequency and number of barriers to adherence among both adherent and nonadherent patients. Odds ratios (ORs) with 95% confidence intervals (CIs) identifying barriers associated with poor adherence. RESULTS Twenty-seven percent of the sample reported poor adherence. Sixty-one percent of all participants cited multiple barriers and 10% cited a single barrier as impediments to optimal adherence. Twenty-nine percent of subjects cited no barriers, although only 13% of patients who cited no barriers were nonadherent. Among nonadherent patients, 31% or more cited each of the 11 barriers as important. Logistic regression analysis, adjusted for age, revealed that the following barriers were associated with higher odds of nonadherence: decreased self-efficacy (OR, 4.7; 95% CI, 2.2-9.7; P ≤ 0.0001), difficulty instilling drops (OR, 2.3; 95% CI, 1.1-4.9; P = 0.03), forgetfulness (OR, 5.6; 95% CI, 2.6-12.1; P ≤ 0.0001), and difficulties with the medication schedule (OR, 2.9; 95% CI, 1.4-6.0; P = 0.006). For each additional barrier cited as important, there was a 10% increased odds of being nonadherent (OR, 1.1; 95% CI, 1.0-1.2; P = 0.01). CONCLUSIONS Each of the 11 barriers was important to at least 30% of surveyed patients with poor adherence, with most identifying multiple barriers to adherence. Low self-efficacy, forgetfulness, and difficulty with drop administration and the medication schedule were barriers associated with poor adherence. Interventions to improve medication adherence must address each patient's unique set of barriers.
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Affiliation(s)
- Paula Anne Newman-Casey
- Department of Ophthalmology & Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan.
| | - Alan L Robin
- Department of Ophthalmology & Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan; Department of Ophthalmology & International Health, Johns Hopkins University, Baltimore, Maryland
| | - Taylor Blachley
- Department of Ophthalmology & Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Karen Farris
- School of Pharmacy, University of Michigan, Ann Arbor, Michigan
| | - Michele Heisler
- School of Public Health, University of Michigan, Ann Arbor, Michigan; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Ken Resnicow
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Paul P Lee
- Department of Ophthalmology & Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
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Dreer LE, Owsley C, Campbell L, Gao L, Wood A, Girkin CA. Feasibility, Patient Acceptability, and Preliminary Efficacy of a Culturally Informed, Health Promotion Program to Improve Glaucoma Medication Adherence Among African Americans: "Glaucoma Management Optimism for African Americans Living with Glaucoma" (GOAL). Curr Eye Res 2015; 41:50-8. [PMID: 25625187 DOI: 10.3109/02713683.2014.1002045] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE/AIMS To examine the feasibility, patient acceptability, and preliminary effectiveness of a culturally informed, health promotion program designed to improve glaucoma medication adherence among African American's (AA's) with glaucoma. MATERIALS/METHODS A sample of 11 AA glaucoma patients (mean age 61 years; 73% women and 27% men) completed a culturally informed and individually tailored, health promotion program developed for AAs titled, "Glaucoma Management Optimism for African Americans Living with Glaucoma" (GOAL)©. The aim of the brief 4-week program is to enhance glaucoma medication adherence through a combination of education, motivational interviewing (MI), and problem-solving training (PST). Feasibility was assessed on the basis of patient satisfaction with the program, number of sessions completed, and length of sessions. Preliminary efficacy was evaluated using a pre-post design to determine whether the program improved objective glaucoma medication adherence via an electronic Travalert dosing aid as well as satisfaction with aspects of glaucoma treatment, health beliefs about medications, glaucoma symptoms, emotional well-being, and intraocular pressure. RESULTS Overall patient satisfaction and acceptability was high for the program, interactions with the health educator, program materials, and the length of sessions. Feasibility was also supported given the need for the program, success in recruitment/retention, and ease of implementing the program with AA glaucoma patients in clinic and/or over the telephone. In terms of preliminary efficacy, patients showed significant pre-post improvements in objective medication adherence rates by 15% (p = 0.03), self-efficacy for glaucoma management (p = 0.02), ease of use in administering eye drops (p = 0.03), glaucoma treatment satisfaction (p = 0.05), beliefs about the necessity of taking glaucoma medications (p = 0.05), and functional visual ocular symptoms (p = 0.03). CONCLUSIONS (GOAL)© holds great promise toward improving glaucoma medication adherence and beliefs among AA's with glaucoma.
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Affiliation(s)
- Laura E Dreer
- a Department of Ophthalmology , University of Alabama at Birmingham , Birmingham , AL , USA and
| | - Cynthia Owsley
- a Department of Ophthalmology , University of Alabama at Birmingham , Birmingham , AL , USA and
| | - Lisa Campbell
- b Department of Psychology , East Carolina University , Greenville , NC , USA
| | - Liyan Gao
- a Department of Ophthalmology , University of Alabama at Birmingham , Birmingham , AL , USA and
| | - Andy Wood
- a Department of Ophthalmology , University of Alabama at Birmingham , Birmingham , AL , USA and
| | - Christopher A Girkin
- a Department of Ophthalmology , University of Alabama at Birmingham , Birmingham , AL , USA and
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Lambert WS, Carlson BJ, van der Ende AE, Shih G, Dobish JN, Calkins DJ, Harth E. Nanosponge-Mediated Drug Delivery Lowers Intraocular Pressure. Transl Vis Sci Technol 2015; 4:1. [PMID: 25599009 DOI: 10.1167/tvst.4.1.1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 11/11/2014] [Indexed: 02/06/2023] Open
Abstract
PURPOSE We examined the efficacy of an extended-release drug delivery system, nanosponge (NS) encapsulated compounds, administered intravitreally to lower intraocular pressure (IOP) in mice. METHODS Bilateral ocular hypertension was induced in mice by injecting microbeads into the anterior chamber. Hypertensive mice received NS loaded with ocular hypotensive drugs via intravitreal injection and IOP was monitored. Retinal deposition and retinal ganglion cell (RGC) uptake of Neuro-DiO were examined following intravitreal injection of Neuro-DiO-NS using confocal microscopy. RESULTS Brimonidine-loaded NS lowered IOP 12% to 30% for up to 6 days (P < 0.02), whereas travoprost-NS lowered IOP 19% to 29% for up to 4 days (P < 0.02) compared to saline injection. Three bimatoprost NS were tested: a 400-nm NS and two 700-nm NS with amorphous (A-NS) or amorphous/crystalline (AC-NS) crosslinkers. A single injection of 400 nm NS lowered IOP 24% to 33% for up to 17 days compared to saline, while A-NS and AC-NS lowered IOP 22% to 32% and 18% to 26%, respectively, for up to 32 days (P < 0.046). Over time retinal deposition of Neuro-DiO increased from 19% to 71%; Neuro-DiO released from NS was internalized by RGCs. CONCLUSIONS A single injection of NS can effectively deliver ocular hypotensive drugs in a linear and continuous manner for up to 32 days. Also, NS may be effective at targeting RGCs, the neurons that degenerate in glaucoma. TRANSLATIONAL RELEVANCE Patient compliance is a major issue in glaucoma. The use of NS to deliver a controlled, sustained release of therapeutics could drastically reduce the number of patients that progress to vision loss in this disease.
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Affiliation(s)
- Wendi S Lambert
- The Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Brian J Carlson
- The Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Grace Shih
- The Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Julia N Dobish
- Vanderbilt Brain Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - David J Calkins
- The Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, USA ; Vanderbilt Brain Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eva Harth
- Department of Chemistry, Vanderbilt University, Nashville, TN, USA
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Abdull MM, Gilbert C, McCambridge J, Evans J. Adapted motivational interviewing to improve the uptake of treatment for glaucoma in Nigeria: study protocol for a randomized controlled trial. Trials 2014; 15:149. [PMID: 24773760 PMCID: PMC4021714 DOI: 10.1186/1745-6215-15-149] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 04/03/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Glaucoma is a chronic eye disease associated with irreversible visual loss. In Africa, glaucoma patients often present late, with very advanced disease. One-off procedures, such as laser or surgery, are recommended in Africa because of lack of or poor adherence to medical treatment. However, acceptance of surgery is usually extremely low. To prevent blindness, adherence to treatment needs to improve, using acceptable, replicable and cost-effective interventions. After reviewing the literature and interviewing patients in Bauchi (Nigeria) motivational interviewing (MI) was selected as the intervention for this trial, with adaptation for glaucoma (MIG). MI is designed to strengthen personal motivation for, and commitment to a specific goal by eliciting and exploring a person's reasons for change within an atmosphere of acceptance and compassion. The aim of this study is to assess whether MIG increases the uptake of laser or surgery amongst glaucoma patients where this is the recommended treatment. The hypothesis is that MIG increases the uptake of treatment. This will be the first trial of MI in Africa. METHODS This is a hospital based, single centre, randomized controlled trial of MIG plus an information sheet on glaucoma and its treatment (the latter being "standard care") compared with standard care alone for glaucoma patients where the treatment recommended is surgery or laser.Those eligible for the trial are adults aged 17 years and above who live within 200 km of Bauchi with advanced glaucoma where the examining ophthalmologist recommends surgery or laser. After obtaining written informed consent, participants will be randomly allocated to MIG plus standard care, or standard care alone. Motivational interviewing will be delivered in Hausa or English by one of two MIG trained personnel. One hundred and fifty participants will be recruited to each arm. The primary outcome is the proportion of participants undergoing laser or surgery within two months of the date given to re attend for the procedure. MIG quality will be assessed using the validated MI treatment integrity scale. DISCUSSION Motivational interviewing may be an important tool to increase the acceptance of treatment for glaucoma. The approach is potentially scalable and may be useful for other chronic conditions in Africa. TRIAL REGISTRATION ISRCTN79330571 (Controlled-Trials.com).
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Affiliation(s)
- Mohammed M Abdull
- Ophthalmology Department, Abubakar Tafawa Balewa University Teaching Hospital, Hospital Road, PMB 0117 Bauchi, Bauchi State, Nigeria
| | - Clare Gilbert
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Jim McCambridge
- Department of Social and Environmental Health research, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E7HT, UK
| | - Jennifer Evans
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Abstract
PURPOSE To elucidate barriers and facilitators related to glaucoma medication adherence among African Americans (AA) with glaucoma and to elicit input from a community-based participatory research team to guide the development of a culturally informed health promotion program for improving glaucoma medication adherence among AAs. METHODS The nominal group technique (NGT), a highly structured focus group methodology, was implemented with 12 separate groups of AA patients with glaucoma (N = 89) to identify barriers and facilitators related to glaucoma medication usage. Participant rank-ordering votes were summed across groups and categorized into themes. Next, an individually and culturally targeted health promotion program promoting appropriate medication adherence was developed based on focus group results and input from a community-based participatory research team. RESULTS The top five barriers included problems with forgetfulness, side effects, cost/affordability, eyedrop administration, and the eyedrop schedule. The most salient top five facilitators were fear or thoughts about the consequences of not taking eyedrops; use of memory aids, cues, or strategies; maintaining a regular routine or schedule for eyedrop administration; ability to afford eyedrops; and keeping eyedrops in the same area. The resulting health promotion program was based on a multicomponent empowerment framework that included glaucoma education, motivational interviewing, and problem-solving training to improve glaucoma medication adherence. CONCLUSIONS Barriers and facilitators related to glaucoma medication adherence among AAs are multifactorial. Based on the NGT themes and input from the community-based participatory research team, a culturally informed health promotion program was designed and holds great promise for improving medication adherence among this vulnerable population.
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Newman-Casey PA, Weizer JS, Heisler M, Lee PP, Stein JD. Systematic review of educational interventions to improve glaucoma medication adherence. Semin Ophthalmol 2013; 28:191-201. [PMID: 23697623 DOI: 10.3109/08820538.2013.771198] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Adherence to prescribed glaucoma medications is often poor, and proper adherence can be challenging for patients. We systematically reviewed the literature and identified eight studies using educational interventions to improve glaucoma medication adherence. Overall, five of the eight studies found that educational interventions lead to a significant improvement in medication adherence, and two additional studies found a trend towards improvement. Using information from this systematic review and Health Behavior Theory, we constructed a conceptual framework to illustrate how counseling and education can improve glaucoma medication adherence. More rigorous studies grounded in Health Behavior Theory with adequately powered samples and longer follow-up are needed.
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Affiliation(s)
- Paula Anne Newman-Casey
- Department of Ophthalmology & Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan 48105, USA.
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Zwikker H, van den Bemt B, van den Ende C, van Lankveld W, den Broeder A, van den Hoogen F, van de Mosselaar B, van Dulmen S. Development and content of a group-based intervention to improve medication adherence in non-adherent patients with rheumatoid arthritis. PATIENT EDUCATION AND COUNSELING 2012; 89:143-151. [PMID: 22878029 DOI: 10.1016/j.pec.2012.07.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 07/09/2012] [Accepted: 07/11/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To describe the systematic development and content of a short intervention to improve medication adherence to disease-modifying anti-rheumatic drugs in non-adherent patients with rheumatoid arthritis (RA). METHODS The intervention mapping (IM) framework was used to develop the intervention. The following IM steps were conducted: (1) a needs assessment; (2) formulation of specific intervention objectives; (3) inventory of methods and techniques needed to design the intervention and (4) production and piloting of the intervention. RESULTS The intervention (consisting of two group sessions led by a pharmacist, a homework assignment, and a follow-up call) aims to improve the balance between necessity and concern beliefs about medication, and to resolve practical barriers in medication taking. The central communication method used is motivational interviewing. CONCLUSION By applying the IM framework, we were able to create a feasible, time-efficient and promising intervention to improve medication adherence in non-adherent RA patients. Intervention effects are currently being assessed in a randomized controlled trial. PRACTICE IMPLICATIONS This paper could serve as a guideline for other health care professionals when developing similar interventions. If the RCT demonstrates sufficient effectiveness of this intervention in reducing medication non-adherence in RA patients, the intervention could be embedded in clinical practice.
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Affiliation(s)
- Hanneke Zwikker
- Department of Rheumatology and Pharmacy, Sint Maartenskliniek, Nijmegen, The Netherlands.
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Robbins LB, Pfeiffer KA, Maier KS, Ladrig SM, Berg-Smith SM. Treatment fidelity of motivational interviewing delivered by a school nurse to increase girls' physical activity. J Sch Nurs 2011; 28:70-8. [PMID: 21970862 DOI: 10.1177/1059840511424507] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Motivational interviewing, which involves the use of person-centered, directive counseling techniques, shows promise for changing adolescent behaviors. The purpose of this article was to describe the methodology and findings related to the treatment fidelity of three face-to-face motivational interviewing sessions involving middle school girls and a school nurse to help the girls increase their moderate-to-vigorous physical activity. The following four areas related to treatment fidelity were addressed: (a) study design, (b) training of interventionists, (c) intervention delivery, and (d) intervention receipt. Findings showed that 34 of 37 (91.9%) girls completed all three sessions. An initial motivational interviewing training workshop followed by evaluation of audiotaped sessions with constructive feedback can result in successful and consistent delivery by a school nurse.
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Affiliation(s)
- Lorraine B Robbins
- Michigan State University College of Nursing, East Lansing, MI 48824, USA.
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Nordmann JP, Akesbi J. Améliorer l’adhérence au traitement des patients glaucomateux : le rôle du médecin. J Fr Ophtalmol 2011; 34:403-8. [DOI: 10.1016/j.jfo.2011.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Revised: 03/30/2011] [Accepted: 04/11/2011] [Indexed: 10/18/2022]
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