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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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Acuff K, Wu JH, Varkhedi V, Baxter SL. Social determinants of health and health disparities in glaucoma: A review. Clin Exp Ophthalmol 2024; 52:276-293. [PMID: 38385607 PMCID: PMC11038416 DOI: 10.1111/ceo.14367] [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: 08/27/2023] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 02/23/2024]
Abstract
Social determinants of health and barriers to care can significantly impact patients' access to glaucoma care and treatment, resulting in disparities within disease presentation, progression, management, and treatment outcomes. The widespread adoption of electronic health record systems has allowed researchers and clinicians to further explore these relationships, identifying factors such as race, ethnicity, and socioeconomic status to be risk factors for more severe disease and lower treatment adherence. These disparities highlight potential targets for interventions to combat these disparities and improve overall patient outcomes. This article provides a summary of the available data on health disparities within glaucoma disease presentation, progression, management, treatment, and outcomes and discusses interventions to improve care delivery and outcomes among patients with glaucoma.
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Affiliation(s)
- Kaela Acuff
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, USA
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California, USA
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, CA, USA
| | - Jo-Hsuan Wu
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, USA
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California, USA
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, CA, USA
| | - Varsha Varkhedi
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, USA
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California, USA
| | - Sally L. Baxter
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, USA
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California, USA
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, CA, USA
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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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Robinson CG, Schempf T, Williams AM, Muir KW, Woolson S, Olsen M, Rosdahl JA. Glaucoma Knowledge and Disease Severity in a Veteran Population: The Medication Adherence in Glaucoma to Improve Care (MAGIC) Study. Ophthalmol Glaucoma 2023; 6:277-282. [PMID: 36400355 DOI: 10.1016/j.ogla.2022.11.001] [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: 07/15/2022] [Revised: 10/11/2022] [Accepted: 11/01/2022] [Indexed: 05/26/2023]
Abstract
PURPOSE To assess the relationship between glaucoma knowledge and disease severity. DESIGN Substudy of a randomized controlled trial at a single Veterans Affairs (VA) eye clinic. PARTICIPANTS Veterans with medically treated open-angle glaucoma who self-reported poor medication adherence. METHODS Participants completed a glaucoma knowledge assessment using the 10-question National Eye Health Education Program (NEHEP) Eye-Q Test on glaucoma knowledge. Disease severity was determined using visual field criteria. Multiple linear regression was used to assess the association of NEHEP Eye-Q score and disease severity, adjusting for age, number of glaucoma medications, race, sex, and VA Care Assessment Needs (CAN) score. MAIN OUTCOME MEASURES In this cross-sectional, preintervention analysis, the main outcome was glaucoma knowledge as measured by the NEHEP Eye-Q Test. RESULTS Among the 200 study participants, glaucoma severity was mild in 53 (27%), moderate in 56 (28%), severe in 74 (37%), and indeterminant in 17 (9%). The NEHEP Eye-Q scores were low across all severity levels. Scored out of 10, the mean (standard deviation) NEHEP Eye-Q scores were 6.06 (1.57) for mild, 6.21 (1.47) for moderate, 6.28 (1.82) for severe, and 5.88 (1.93) for indeterminate stage. There was no evidence of a significant association between NEHEP scores and disease severity categories (P = 0.78). A regression model did not identify a significant estimated association between NEHEP Eye-Q scores and disease severity after adjusting for age, CAN risk score, number of glaucoma medications, race, and sex. CONCLUSIONS There was no difference in level of glaucoma knowledge based on disease severity. Education-based interventions may benefit patients across all glaucoma stages. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
| | - Tadhg Schempf
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Andrew M Williams
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Kelly W Muir
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina; Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Sandra Woolson
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Maren Olsen
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina; Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Jullia A Rosdahl
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina.
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Zhao QF, Hirneiss C. Does Diabetes Influence Adherence in Glaucoma Patients? Klin Monbl Augenheilkd 2023; 240:136-141. [PMID: 36351553 DOI: 10.1055/a-1975-2396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
With chronic diseases, patient adherence plays a crucial role in delaying disease progression and in determining the success of therapy. Problems arise not only from low medication adherence, but also non-adherence to recommended follow-up examinations. Obtaining an accurate estimate of adherence is difficult, especially in glaucoma patients, due to the fact that most antihypertensive drugs are administered in the form of eye drops. There is great variability in the published adherence values for glaucoma patients. Most studies report an average medication adherence of approximately 70%, with around 50% of patients having good adherence (at least 80% of medication administered as planned). Furthermore, 6.8 - 31.4% of the eye drops do not end up in the patient's eye, which means there is even less active ingredient to achieve a therapeutic effect. Glaucoma patients also show low persistence and adherence to follow-up appointments. Since diabetes increases the risk for POAG and secondary glaucoma and given that diabetics have particularly low adherence, the question arose whether a diabetes diagnosis is associated with reduced adherence in glaucoma patients. Previous studies found no significant association between diabetes and reduced adherence in glaucoma patients, although a significant impact of elevated HbA1c on adherence in glaucoma patients was found in one study. However, this connection still needs to be examined more closely in studies with larger samples.
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Affiliation(s)
- Qifan Felix Zhao
- Glaukomsprechstunde, Augenklinik und Poliklinik des Klinikums der Universität München, München, Deutschland
| | - Christoph Hirneiss
- Glaukomsprechstunde, Augenklinik und Poliklinik des Klinikums der Universität München, München, Deutschland
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Energy Dose-Response in Selective Laser Trabeculoplasty: A Review. J Glaucoma 2022; 31:e49-e68. [PMID: 35701875 PMCID: PMC9362340 DOI: 10.1097/ijg.0000000000002062] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/18/2022] [Indexed: 02/04/2023]
Abstract
PRCIS A literature review of selective laser trabeculoplasty (SLT) energy dose-response found no definitive relationship between intraocular pressure (IOP) reduction with respect to total or pulse energy, race, pigmentation, or application pattern. PURPOSE SLT is a safe and effective treatment for lowering IOP. Although evidence is mounting for the advantage of its use as a first-line treatment for IOP reduction, the SLT procedures in use vary widely. The purpose of this literature review was to investigate whether there were any relationships between SLT energy and efficacy for lowering IOP in the published literature. METHODS A literature review was undertaken that included studies in which energy levels required for successful SLT treatment were investigated: in general, with respect to angle pigmentation, race or ethnicity, and treatment arc extent. RESULTS There was no indication that higher (or lower) energy used in the treatment leads to greater (or less) IOP reduction. Similar results were obtained regarding the level of trabecular meshwork pigmentation. Race was not found to be associated with altered dose response in SLT. There were indications that treating the full 360 degrees, as opposed to smaller arcs, could be beneficial for more IOP reduction. IOP reduction from SLT was found to be similar to that provided by topical medications. CONCLUSIONS The optimal energy level of SLT needed for IOP reduction has not yet been definitively established, with all reported pulse energies resulting in similar IOP reduction. Furthermore, similar lack of conclusive findings exists regarding optimal SLT energy dosage for use in different races and degrees of trabecular meshwork pigmentation. This parameter and each of the abovementioned factors requires further research.
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Oydanich M, Shah Y, Shah K, Khouri AS. An Analysis of the Quality, Reliability, and Popularity of YouTube Videos on Glaucoma. Ophthalmol Glaucoma 2022; 5:306-312. [PMID: 34637976 DOI: 10.1016/j.ogla.2021.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/23/2021] [Accepted: 10/04/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE To evaluate the quality, reliability, and popularity of videos relating to glaucoma on YouTube. DESIGN Retrospective, cross-sectional study of YouTube videos about glaucoma. PARTICIPANTS One hundred YouTube videos were analyzed for this study. METHODS An online YouTube search for glaucoma videos was conducted simulating a user search using the keywords glaucoma, high eye pressure, and high intraocular pressure. The first 100 videos were analyzed, and each video was evaluated by 2 independent reviewers using the modified DISCERN (scale, 1-5), Journal of the American Medical Association (JAMA; scale, 0-4), and Global Quality (GQ; scale, 1-5) criteria to assess quality and reliability. Videos were categorized further into 3 groups depending on the source of their upload. Group 1 comprised videos uploaded by academic or government institutions, group 2 comprised videos uploaded by private medical practices, and group 3 comprised videos uploaded by independent users. MAIN OUTCOME MEASURES Modified DISCERN, JAMA, and GQ scores for quality and reliability of information and video power index (VPI) for video popularity. RESULTS No substantial difference in scoring was observed between the 2 independent reviewers. The overall mean ± standard error (SE) scores were modified DISCERN score, 3.81 ± 0.06; JAMA score, 2.93 ± 0.07; and GQ score, 3.98 ± 0.06. The overall mean ± SE VPI score was 9.9 ± 2.9. Significant positive correlations were found between video popularity and quality of information for all 3 criteria (P < 0.05). The videos in groups 1 and 2 showed higher modified DISCERN scores than those in group 3, but did not score higher with either the JAMA or GQ criteria. Videos in group 3 were the most popular when compared with videos in groups 1 or 2 (P < 0.01). CONCLUSIONS Overall, many of the videos had adequate quality and reliability scores. No difference was found among groups 1 through 3 for 2 of the 3 criteria used, suggesting a similar quality of information provided among academic, private, and independent sources.
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Affiliation(s)
- Marko Oydanich
- Department of Ophthalmology & Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Yash Shah
- Department of Ophthalmology & Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Khelly Shah
- Department of Ophthalmology & Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Albert S Khouri
- Department of Ophthalmology & Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey.
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Gatwood J, Brooks C, Meacham R, Abou-Rahma J, Cernasev A, Brown E, Kuchtey RW. Facilitators and Barriers to Glaucoma Medication Adherence. J Glaucoma 2022; 31:31-36. [PMID: 34772874 DOI: 10.1097/ijg.0000000000001965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/20/2021] [Indexed: 10/19/2022]
Abstract
PRCIS Patient education and dosing self-efficacy are important factors related to ongoing adherence to glaucoma topical treatment, and patients view their disease management as a shared effort with their provider. PURPOSE Glaucoma affects nearly 3 million Americans, and medication adherence has been reported to be as low as 20% in this patient population; however, key limitations to our understanding of this behavior in adults with glaucoma exist. PATIENTS AND METHODS This research used an electronic survey including validated concepts related to topical medication use and an in-person interview to investigate the influencers of and solutions for challenges to medication adherence in adults with glaucoma. Patient eligibility was determined upon arrival to a regularly-scheduled visit to the Vanderbilt Eye Institute, during which they were asked for consent to complete the survey. Responses were captured by tablet and assessed using descriptive and inferential statistics. The primary focus was instrument correlations with the Adherence to Refills and Medications Scale score and were run between Adherence to Refills and Medications Scale, and the totaled score for each individual questionnaire as well as individual items. Recorded interviews were thematically assessed by multiple study team members. RESULTS Survey results of adults with glaucoma suggested that self-efficacy, forgetfulness, fear of side effects, and dosing ability were all related to self-reported medication adherence. Despite most having glaucoma for several years, discrepancies in disease knowledge were observed. Patient interviews uncovered 3 overall themes related to glaucoma treatment: (1) glaucoma management as a shared responsibility; (2) the importance of patient education; and (3) specific adherence facilitators and barriers. CONCLUSION Glaucoma medication adherence interventions may benefit from focusing on developing patient medication-taking self-efficacy, disease-related education, and engagement with their provider.
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Affiliation(s)
- Justin Gatwood
- University of Tennessee Health Science Center College of Pharmacy
| | - Callee Brooks
- University of Tennessee Health Science Center College of Pharmacy
| | - Ryan Meacham
- University of Tennessee Health Science Center College of Pharmacy
| | | | - Alina Cernasev
- University of Tennessee Health Science Center College of Pharmacy
| | - Eric Brown
- Department of Ophthalmology and Visual, Sciences, Vanderbilt Eye Institute, Vanderbilt University Medical Center, Vanderbilt University
| | - Rachel W Kuchtey
- Department of Ophthalmology and Visual, Sciences, Vanderbilt Eye Institute, Vanderbilt University Medical Center, Vanderbilt University
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN
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Miller DJ, Niziol LM, Elam AR, Heisler M, Lee PP, Resnicow K, Musch DC, Darnley-Fisch D, Mitchell J, Newman-Casey PA. Demographic, Clinical, and Psychosocial Predictors of Change in Medication Adherence in the Support, Educate, Empower Program. Ophthalmol Glaucoma 2022; 5:47-57. [PMID: 34098169 PMCID: PMC8716681 DOI: 10.1016/j.ogla.2021.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/13/2021] [Accepted: 06/01/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE To investigate whether demographic, clinical, or psychosocial factors act as moderators of change in medication adherence in the Support, Educate, Empower (SEE) program. DESIGN Prospective, single-arm pilot study with a pre-post design. PARTICIPANTS Patients with glaucoma aged ≥ 40 years and taking ≥ 1 glaucoma medication were recruited from the University of Michigan Kellogg Eye Center. Those who had electronically measured adherence ≤ 80% in the 3-month eligibility monitoring period were enrolled in the SEE program. METHODS Medication adherence was monitored electronically during the 7-month intervention and calculated as the percentage of doses taken correctly. Change in adherence at different points in the SEE program and cumulative change in adherence were modeled with linear regression, and baseline demographic, clinical, and psychosocial factors were investigated for significant associations. MAIN OUTCOME MEASURES Demographic, clinical, and psychosocial variables associated with change in medication adherence in the SEE program. RESULTS Thirty-nine participants completed the SEE program. These participants were on average 63.9 years old (standard deviation [SD], 10.7 years), 56% (n = 22) were male, 44% (n = 17) were White, and 49% (n = 19) were Black. Medication adherence improved from an average of 59.9% (SD, 18.5%) at baseline to 83.6% (SD, 17.5%) after the final SEE session, for an increase of 23.7% (SD, 17.5%). Although participants with lower income (< $25 000 and $25 000-50 000 vs. >$50 000) had lower baseline adherence (48.4% and 64.1% vs. 70.4%), these individuals had greater increases in adherence during the first month of medication reminders (19.6% and 21.6% vs. 10.2%; P = 0.05 and P = 0.007, respectively). Participants taking fewer glaucoma medications also had significantly greater increases in adherence with medication reminders (P < 0.001). Those with higher levels of glaucoma-related distress (GD) had lower baseline adherence and greater increases in adherence with glaucoma coaching (P = 0.06). CONCLUSIONS Patient-level factors associated with relatively greater improvements in medication adherence through the SEE Program included lower income, fewer glaucoma medications, and increased GD. These findings demonstrate that the SEE program can improve glaucoma self-management even among participants with social and psychological barriers to medication adherence.
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Affiliation(s)
- David J. Miller
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan,Department of Foundational Sciences, Central Michigan University College of Medicine, Mount Pleasant, Michigan
| | - Leslie M. Niziol
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Angela R. Elam
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Michele Heisler
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Paul P. Lee
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Kenneth Resnicow
- Department of Health Behavior and Health Education, University of Michigan Medical School, Ann Arbor, Michigan
| | - David C. Musch
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan,Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
| | | | - Jamie Mitchell
- School of Social Work, University of Michigan, Ann Arbor, MI
| | - Paula Anne Newman-Casey
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
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Cho J, Niziol LM, Lee PP, Heisler M, Resnicow K, Musch DC, Newman-Casey PA. Comparison of Medication Adherence Assessment Tools to Identify Glaucoma Medication Nonadherence. Ophthalmol Glaucoma 2022; 5:137-145. [PMID: 34358735 PMCID: PMC8814049 DOI: 10.1016/j.ogla.2021.07.012] [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: 05/27/2021] [Revised: 07/15/2021] [Accepted: 07/28/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the accuracy of 5 subjective self-assessment tools (3 adherence measures and 2 psychometric scales) and pharmacy refill data in predicting objective electronically monitored nonadherence. DESIGN Prospective cohort study. PARTICIPANTS Glaucoma patients (> 40 years old, >1 medication with poor self-reported adherence) were recruited from University of Michigan Kellogg Eye Center for a study assessing the impact of a personalized glaucoma coaching program on medication adherence. METHODS Participants completed an initial assessment including 5 self-assessment tools and a 3-month period of electronic monitoring of glaucoma medication adherence (AdhereTech); pharmacy refill data were obtained. Electronically monitored adherence was calculated monthly as the percentage of doses taken on time. The median of these adherence rates was designated as baseline adherence. Patients with adherence of ≤80% by electronic monitoring were considered nonadherent. Self-assessment tools were scored, and pharmacy refill data were summarized as the proportion of days covered. Correlation between measures of adherence was estimated with Pearson and Spearman correlation coefficients. Receiver operating characteristic curves, including estimation of area under the curve (AUC), sensitivity, specificity, and accuracy were used to compare measures of adherence with respect to predicting electronically monitored nonadherence. MAIN OUTCOME MEASURES Accuracy of self-reported and pharmacy refill data adherence measures in predicting electronically monitored nonadherence. RESULTS Ninety-five patients completed 3 months of electronic monitoring with a median monthly adherence of 74 (± 21%); 53 patients (56%) were nonadherent. Pharmacy refill data were not correlated significantly with electronically monitored medication adherence (r = 0.12; P = 0.2). Of all the measures, a single-item adherence question ("Over the past month, what percentage of your drops do you think you took correctly?") showed the largest correlation with median electronically monitored adherence (r = 0.47; P < 0.0001), largest AUC for predicting nonadherence (AUC = 0.76 [95% confidence interval [CI], 0.66-0.87]), best accuracy (71% [95% CI, 61%-82%]), and good sensitivity (84% [95% CI, 73%-96%]). CONCLUSIONS The single-item question was the most accurate in predicting electronically monitored nonadherence among participants with poor self-reported adherence. In clinical practice, where alternatives are too resource intensive, this free single-item screening question can help to identify glaucoma patients at risk of poor medication adherence with reasonable accuracy.
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Affiliation(s)
- Juno Cho
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan
| | - Leslie M. Niziol
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan
| | - Paul P. Lee
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan
| | - Michele Heisler
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Ken Resnicow
- School of Public Health, University of Michigan, Ann Arbor, MI
| | - David C. Musch
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan
| | - Paula Anne Newman-Casey
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan.
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12
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Muir KW, Rosdahl JA, Hein AM, Woolson S, Olsen MK, Kirshner M, Sexton M, Bosworth HB. Improved Glaucoma Medication Adherence in a Randomized Controlled Trial. Ophthalmol Glaucoma 2022; 5:40-46. [PMID: 33892170 DOI: 10.1016/j.ogla.2021.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/08/2021] [Accepted: 04/14/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To test the effectiveness of an intervention designed to improve glaucoma medication adherence. DESIGN Randomized, controlled trial at a Veterans Affairs (VA) eye clinic. PARTICIPANTS Veterans with medically treated glaucoma who reported poor adherence and their companions if applicable. METHODS Participants, and their companions if applicable, were randomized to receive an intervention to improve medication adherence that included glaucoma education, personalized disease management suggestions, and a reminder aid, or the control arm that received education regarding general eye health. MAIN OUTCOME MEASURES The average proportion of prescribed glaucoma medication doses taken on schedule over the 6 months after randomization according to an electronic monitor between participants in the 2 arms. RESULTS The mean proportion of prescribed doses taken on schedule was higher in the intervention group compared with controls (0.85 vs. 0.62, P < 0.0001). The difference in proportions between the 2 groups did not vary in regressions models adjusted for companion status, frequency of dosing, and race. The longitudinal model indicated that the intervention group had significantly higher adherence during the first month after randomization and continued to stay higher through 6 months (month by treatment interaction, P = 0.003). CONCLUSIONS A multifaceted intervention can help improve glaucoma medication adherence.
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Affiliation(s)
- Kelly W Muir
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina; Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina.
| | - Jullia A Rosdahl
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Aaron M Hein
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Sandra Woolson
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Maren K Olsen
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Miriam Kirshner
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Malina Sexton
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Hayden B Bosworth
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Department of Population Health Sciences, Duke University, Durham, North Carolina; Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina
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13
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Realini T, Gazzard G, Latina M, Kass M. Low-energy Selective Laser Trabeculoplasty Repeated Annually: Rationale for the COAST Trial. J Glaucoma 2021; 30:545-551. [PMID: 33428350 PMCID: PMC8238780 DOI: 10.1097/ijg.0000000000001788] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/20/2020] [Indexed: 11/25/2022]
Abstract
The recent Laser in Glaucoma and Ocular Hypertension Trial provided the evidentiary basis for a paradigm shift away from the historical medication-first approach to glaucoma--which has numerous limitations, the most important of which is poor adherence to therapy --and toward a laser-first approach. Now 20 years after its commercialization, selective laser trabeculoplasty (SLT) is routinely performed consistently with its initial description, with energy titrated to the appearance of fine, champagne-like cavitation bubbles. A recent data set suggested that lower energy SLT, applied as primary therapy and repeated annually irrespective of intraocular pressure--rather than pro re nata when its effect wanes and irrespective of intraocular pressure rises --yields longer medication-free survival than standard energy SLT repeated pro re nata. A new study--Clarifying the Optimal Application of SLT Therapy --has been initiated to explore this preliminary finding in a pair of consecutive randomized trials. Herein, we provide an evidence-based rationale for the use of low-energy SLT repeated annually as primary therapy for mild to moderate primary open-angle glaucoma or high-risk ocular hypertension.
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Affiliation(s)
- Tony Realini
- Department of Ophthalmology and Visual Sciences, West Virginia University, Morgantown, WV
| | - Gus Gazzard
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, London, UK; University College London, UK
| | - Mark Latina
- Department of Ophthalmology, Tufts University, Boston, MA
| | - Michael Kass
- Department of Ophthalmology and Visual Sciences, Washington University, St. Louis, MO
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14
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Ooms A, Shaikh I, Patel N, Kardashian-Sieger T, Srinivasan N, Zhou B, Wilson L, Szirth B, Khouri AS. Use of Telepresence Robots in Glaucoma Patient Education. J Glaucoma 2021; 30:e40-e46. [PMID: 33337723 DOI: 10.1097/ijg.0000000000001731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/16/2020] [Indexed: 11/26/2022]
Abstract
PRCIS Telepresence robots (TR) present the versatility to effectively provide remote educational sessions for patients affected by glaucoma to improve disease knowledge. Given COVID-19's effect on clinical practice, TR can maintain social distancing when educating patients. PURPOSE TR are devices that allow remote users to have a mobile presence anywhere. We compared the effect of an education session given by an in-person educator versus a TR on glaucoma knowledge and identified factors that impact patient education. METHODS Eighty-five glaucoma patients were split into control, human, and TR groups. We measured glaucoma knowledge scores (KS) using the National Eye Institute's Eye-Q Test. Human and TR groups had the education session with a human or TR followed by the questionnaire. The control group was administered the questionnaire without an education session. Treatment regimen recall (RR) >90% was considered a success. We used linear regression and binary logistic regression to determine variables that affect KS and RR, respectively. RESULTS Mean age was 58.3±2.8 years. 49% were female. Mean KS were 5.8±0.7 in the control group (n=31), 7.9±0.5 in the TR group (n=26), and 8.4±0.5 in the human group (n=28). Control participants had a lower mean KS than the human or TR groups (P<0.001). Having the education session (2.5, P<0.001), education greater than high school (0.8, P=0.016), and diabetes (-0.7, P=0.037) affected KS. Having diabetes (odds ratio=0.14, P=0.014) negatively affected RR. Having the education session may affect RR (odds ratio=5.47, P=0.07), warranting additional studies. CONCLUSIONS Education sessions with a human and TR improved patients' glaucoma KS. TRs may serve as an alternative to in-person education sessions and allow educators to safely and effectively educate patients remotely to adhere to COVID-19 social distancing guidelines.
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Affiliation(s)
- Ashley Ooms
- Rutgers New Jersey Medical School, Newark, NJ
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15
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Rosdahl JA, Hein AM, Bosworth HB, Woolson S, Olsen M, Kirshner M, Hung A, Muir KW. Randomized controlled trial of an education-based intervention to improve medication adherence: Design considerations in the medication adherence in glaucoma to improve care study. Clin Trials 2021; 18:343-350. [PMID: 33487050 PMCID: PMC10048058 DOI: 10.1177/1740774520988291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Glaucoma treatment requires patients to follow daily, often times complex, eye drop regimens, but adherence is poor for many patients, putting them at risk for irreversible vision loss. A comprehensive approach is needed to address the challenges in the self-management of glaucoma. The purpose of this study is to improve glaucoma medication adherence in Veterans with medically treated glaucoma using an education-based intervention. METHODS/DESIGN This study is a single-site randomized controlled trial enrolling 200 Veterans and their companions, if companions are involved in their care. It has two arms: an intervention group and a control group. Participants in the intervention group receive an educational session with a non-physician interventionist and are provided with an AdhereTech smart bottle with the reminder functions activated. The control group is designed as an attention control such that they have a session on general eye health and are provided with a smart bottle but without the reminder functions activated. The primary outcome is the proportion of prescribed doses taken on schedule over 6 months following randomization according to the smart bottle. Secondary outcomes include intensification of glaucoma treatment, cost of intervention delivery, and cost-effectiveness of the intervention over 12 months. DISCUSSION The education-based intervention that we are testing is comprehensive in scope, to encompass a variety of barriers to adherence that glaucoma patients encounter, but personalized to address issues facing individual patients. Particular attention was given to feasibility in the real-world setting, as the high throughput of patients and lack of reimbursement for educational encounters in ophthalmology would limit implementation of a resource-intensive intervention.
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Affiliation(s)
- Jullia A Rosdahl
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Aaron M Hein
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Hayden B Bosworth
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.,Department of Population Health Sciences, 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
| | - Sandra Woolson
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Maren Olsen
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Miriam Kirshner
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Anna Hung
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, 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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16
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Cadel L, Cimino SR, Rolf von den Baumen T, James KA, McCarthy L, Guilcher SJT. Medication Management Frameworks in the Context of Self-Management: A Scoping Review. Patient Prefer Adherence 2021; 15:1311-1329. [PMID: 34163148 PMCID: PMC8216068 DOI: 10.2147/ppa.s308223] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/29/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Many individuals take multiple prescribed and unprescribed medications, also known as polypharmacy, which can be problematic. Improving medication self-management is important; however, most medication management frameworks focus on adherence and limit the integration of the core components of self-management. Therefore, the objective of this scoping review was to identify what is reported in the literature on medication management frameworks or models within the context of self-management. METHODS Electronic databases (Medline, Embase, CINAHL and Cochrane Library) and grey literature (healthcare and government organization websites) were searched for articles that described a framework or model developed or adapted for medication management, included components of self-management and was published from January 2000 to January 2020. During the screening of titles and abstracts, 5668 articles were reviewed, 5242 were excluded and 426 were then assessed at the full-text level. Thirty-nine articles met the eligibility criteria and were included in the review. RESULTS About half of the frameworks were newly developed (n=20), while the other half were adapted from, or applied, a previous model or framework (n=19). The majority of frameworks focused on medication adherence and most of the self-management domains were categorized as medical management, followed by emotional and role management. CONCLUSION Medication self-management is a complex process and often impacts multiple areas of an individual's life. It is important for future frameworks to incorporate a comprehensive, holistic conceptualization of self-management that is inclusive of the three self-management domains - medical, emotional and role management.
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Affiliation(s)
- Lauren Cadel
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Stephanie R Cimino
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- St. John’s Rehab, Sunnybrook Health Sciences Centre, North York, Ontario, Canada
| | | | - Kadesha A James
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Lisa McCarthy
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | - Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Correspondence: Sara JT Guilcher Leslie Dan Faculty of Pharmacy, 144 College Street, Room 604, Toronto, ON, M5S 3M2, CanadaTel + 1-416-946-7020 Email
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17
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Kashaf MS, Jampel HD. Adherence Studies with Short Follow-up Do Not Suffice for a Chronic Disease Like Open-Angle Glaucoma. Ophthalmol Glaucoma 2020; 3:225-227. [PMID: 33008555 DOI: 10.1016/j.ogla.2020.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 05/29/2020] [Indexed: 06/11/2023]
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18
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Bilger M, Wong TT, Lee JY, Howard KL, Bundoc FG, Lamoureux EL, Finkelstein EA. Using Adherence-Contingent Rebates on Chronic Disease Treatment Costs to Promote Medication Adherence: Results from a Randomized Controlled Trial. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2019; 17:841-855. [PMID: 31317511 PMCID: PMC6885505 DOI: 10.1007/s40258-019-00497-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Poor adherence to medications is a global public health concern with substantial health and cost implications, especially for chronic conditions. In the USA, poor adherence is estimated to cause 125,000 deaths and cost $US100 billion annually. The most successful adherence-promoting strategies that have been identified so far have moderate effect, are relatively costly, and raise availability, feasibility, and/or scalability issues. OBJECTIVE The main objective of SIGMA (Study on Incentives for Glaucoma Medication Adherence) was to measure the effectiveness on medication adherence of a novel incentive strategy based on behavioral economics that we refer to as adherence-contingent rebates. These rebates offered patients a near-term benefit while leveraging loss aversion and regret and increasing the salience of adherence. METHODS SIGMA is a 6-month randomized, controlled, open-label, single-center superiority trial with two parallel arms. A total of 100 non-adherent glaucoma patients from the Singapore National Eye Centre were randomized into intervention (adherence-contingent rebates) and usual care (no rebates) arms in a 1:1 ratio. The primary outcome was the mean change from baseline in percentage of adherent days at Month 6. The trial registration number is NCT02271269 and a detailed study protocol has been published elsewhere. FINDINGS We found that participants who were offered adherence-contingent rebates were adherent to all their medications on 73.1% of the days after 6 months, which is 12.2 percentage points (p = 0.027) higher than in those not receiving the rebates after controlling for baseline differences. This better behavioral outcome was achieved by rebates averaging 8.07 Singapore dollars ($US5.94 as of 2 November 2017) per month during the intervention period. CONCLUSION This study shows that simultaneously leveraging several insights from behavioral economics can significantly improve medication adherence rates. The relatively low cost of the rebates and significant health and cost implications of medication non-adherence suggest that this strategy has the potential to cost-effectively improve health outcomes for many conditions.
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Affiliation(s)
- Marcel Bilger
- Health Economics and Policy, Vienna University of Business and Economics, Welthandelsplatz 1, Building D4, 1020, Vienna, Austria.
- Health Services & Systems Research Program, Duke-NUS Medical School, Singapore, Singapore.
| | - Tina T Wong
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
| | - Jia Yi Lee
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
| | - Kaye L Howard
- Health Services & Systems Research Program, Duke-NUS Medical School, Singapore, Singapore
| | - Filipinas G Bundoc
- Health Services & Systems Research Program, Duke-NUS Medical School, Singapore, Singapore
| | - Ecosse L Lamoureux
- Health Services & Systems Research Program, Duke-NUS Medical School, Singapore, Singapore
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
| | - Eric A Finkelstein
- Health Services & Systems Research Program, Duke-NUS Medical School, Singapore, Singapore
- Duke Global Health Institute, Duke University, Durham, NC, USA
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19
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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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20
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Piyasena MMPN, Zuurmond M, Yip JLY, Murthy GVS. Process of adaptation, development and assessment of acceptability of a health educational intervention to improve referral uptake by people with diabetes in Sri Lanka. BMC Public Health 2019; 19:614. [PMID: 31113393 PMCID: PMC6528317 DOI: 10.1186/s12889-019-6880-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 04/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One major barrier to uptake of diabetic retinopathy (DR) services is lack of knowledge and awareness of DR among the people with diabetes (PwDM). Targeted health education (HE) can be a key element in improving the uptake of eye care services. Such interventions are lacking in Sri Lanka. METHODS A local context specific HE intervention (HEI) was developed by adopting available resources and incorporating views from PwDM and key stakeholders. Four sessions of participatory workshops with PwDM (20 Sinhala and 13 Tamil speaking) and two stage 12 stakeholder interviews were conducted to both develop and pre-test the material. The products were a video and a leaflet, delivered at a medical clinic to a sample of 45 PwDM identified as having DR. Semi-structured interviews were conducted after 4 weeks, to evaluate the acceptability and comprehension of the HEI. Additionally, nine interviews were conducted with clinical providers to explore process issues related to delivery of the HEI. Data analysis was conducted using thematic analysis. RESULTS The lack of knowledge and awareness on DR, and of the importance of regular DR screening and follow up, combined with poor information on referral pathways were key elements identified from the workshops with PwDM. The stakeholders prioritised the importance of using simple language, and the need for emphasis on improving understanding about the asymptomatic phase of DR. The overall acceptability of the HEI material was satisfactory, although there was some difficulty with interpretation of medical images. Overall, although PwDM liked the ideas of the video, the leaflet was seen as a more practical option, given the busy clinic environment. The key issue was both formats required interaction with the provider, in order to support understanding of the messages. CONCLUSIONS The process of adapting HE material is not simply translation into the appropriate language. Instead, a tailored approach in a country, context and particular health services setting is needed. This study illustrates the value of using a participatory approach and involving PwDM and stakeholders in the adaptation and pilot testing of a HEI to improve uptake of screening for DR in the context of Sri Lanka.
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Affiliation(s)
- M. M. P. N. Piyasena
- Vitreo-retina unit, National Eye Hospital, Colombo 10, Sri Lanka
- Clinical Research Department, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Maria Zuurmond
- International Centre for Evidence in Disability, Clinical Research Department, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Jennifer L. Y. Yip
- Clinical Research Department, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - G. V. S. Murthy
- Clinical Research Department, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
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21
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Spencer SKR, Shulruf B, McPherson ZE, Zhang H, Lee MB, Francis IC, Bank A, Coroneo MT, Agar A. Factors Affecting Adherence to Topical Glaucoma Therapy: A Quantitative and Qualitative Pilot Study Analysis in Sydney, Australia. Ophthalmol Glaucoma 2019; 2:86-93. [PMID: 32672609 DOI: 10.1016/j.ogla.2019.01.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 01/13/2019] [Accepted: 01/16/2019] [Indexed: 01/19/2023]
Abstract
PURPOSE To assess which factors in the lives and disease of patients with glaucoma affect their adherence to topical glaucoma therapy and the quantitative significance of this effect. To assess qualitatively the most influential barriers to adherence from the perspective of the patient. DESIGN Multicenter, prospective, cross-sectional pilot study. PARTICIPANTS A total of 145 patients, attending outpatient metropolitan glaucoma clinics in Sydney, Australia, who were prescribed topical glaucoma medications. METHODS A structured interview-based questionnaire was conducted with 145 individuals using glaucoma eye drops that had been prescribed at least 2 weeks previously. The questionnaire involved 2 novel questions on adherence, 29 questions on factors identified or postulated in the literature as affecting adherence for quantitative analysis, and 1 open-response question on patient-identified causes of nonadherence for qualitative analysis. This questionnaire represents the broadest coverage of factors hypothesized to affect adherence in a single study in the glaucoma medication adherence literature to date. MAIN OUTCOME MEASURES Adherence rate, risk factors for poor adherence, and patient-identified barriers to adherence. RESULTS In response to the question "How many days have you missed a drop in the last 2 weeks," 69.7% of patients reported total adherence. Four factors were significantly related to an increased likelihood of reporting having missed drops in the last 2 weeks. These were difficulty applying drops (odds ratio [OR], 2.35; 95% confidence interval [CI], 1.02-5.44; P < 0.05), a past or current diagnosis of depression (OR, 3.61; 95% CI, 1.53-8.52; P < 0.01), patient self-rating of own memory ≤ 7 of 10 (OR, 3.15; 95% CI, 1.36-7.30; P < 0.01), and self-reported motivation score ≤ 6 of 10 (OR, 10.94; 95% CI, 3.00-39.81; P < 0.01). Patient understanding of glaucoma, ethnicity, and socioeconomic status were among the 25 factors found not to have a statistically significant correlation with adherence. CONCLUSIONS There is a significant proportion of patients taking their topical glaucoma medications less often than prescribed. Adherence to topical glaucoma therapies is negatively correlated to several factors: difficulty applying drops, a past or current diagnosis of depression, poor self-rating of own memory, and poor self-rating of own motivation. These may prove useful in designing interventions to improve adherence in these patients.
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Affiliation(s)
- Sascha K R Spencer
- The University of New South Wales, Sydney, NSW, Australia; Prince of Wales Hospital, Sydney, NSW, Australia
| | - Boaz Shulruf
- The University of New South Wales, Sydney, NSW, Australia
| | | | - Helen Zhang
- The University of New South Wales, Sydney, NSW, Australia; Prince of Wales Hospital, Sydney, NSW, Australia
| | - Mitchell B Lee
- Prince of Wales Hospital, Sydney, NSW, Australia; Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Ian C Francis
- The University of New South Wales, Sydney, NSW, Australia; Prince of Wales Hospital, Sydney, NSW, Australia; Chatswood Eye Specialists, Sydney, NSW, Australia
| | - Allan Bank
- The University of New South Wales, Sydney, NSW, Australia; Prince of Wales Hospital, Sydney, NSW, Australia; Chatswood Eye Specialists, Sydney, NSW, Australia
| | - Minas T Coroneo
- The University of New South Wales, Sydney, NSW, Australia; Prince of Wales Hospital, Sydney, NSW, Australia
| | - Ashish Agar
- The University of New South Wales, Sydney, NSW, Australia; Prince of Wales Hospital, Sydney, NSW, Australia; Marsden Eye Specialists, Sydney, NSW, Australia.
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22
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Newman-Casey PA, Niziol LM, Mackenzie CK, Resnicow K, Lee PP, Musch DC, Heisler M. Personalized behavior change program for glaucoma patients with poor adherence: a pilot interventional cohort study with a pre-post design. Pilot Feasibility Stud 2018; 4:128. [PMID: 30062043 PMCID: PMC6055343 DOI: 10.1186/s40814-018-0320-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 07/05/2018] [Indexed: 01/17/2023] Open
Abstract
Background About half of people with glaucoma do not adhere to their recommended medications. Interventions for other chronic conditions have successfully utilized reminder systems and motivational interviewing (MI)-based counseling. This study was designed to pilot a personalized intervention that leverages these strategies to assess their impact on medication adherence in glaucoma patients. Methods Glaucoma patients taking ≥ 1 medication will be pre-screened by telephone survey for adherence to their medication(s). Those who self-report poor adherence will be enrolled in a 3-month monitoring period to measure medication adherence using electronic medication monitors. Participants who are non-adherent (take </=80% of their medication doses) over the 3-month run in phase will be eligible for the study. We plan to enroll 57 participants who are non-adherent to their medications. Participants' adherence will then be continuously measured with electronic medication monitors, by self-report, and via pharmacy refill data over 2 years, during which two successively more resource-intensive components of an intervention aimed to improve medication adherence will be administered. The first component is a 3-month period of reminders (audio and/or visual) and text message or automated phone call if a dose of medication is not taken within a pre-specified time frame. The second component is a 6-month MI-based counseling program with a trained glaucoma counselor. This component uses the eyeGuide, a computer-based personalized behavior change program that enables para-professional staff to provide personalized education and counseling for glaucoma. The primary outcome is change in medication adherence. The secondary outcomes include changes in clinical outcomes (intraocular pressure, IOP, and IOP fluctuation) and psychosocial mediators of adherence (e.g., competence, energy for change and satisfaction). Participants will undergo semi-structured interviews at 12 months to give feedback about the counseling program in order to improve it. Discussion This pilot study will provide insight into ways to deliver more personalized health care to non-adherent glaucoma patients in order to better support them in managing their chronic disease. Trial registration Retrospectively registered with ClinicalTrials.gov (NCT03159247).
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Affiliation(s)
- Paula Anne Newman-Casey
- 1Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, 1000 Wall Street, Ann Arbor, MI 48105 USA
| | - Leslie M Niziol
- 1Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, 1000 Wall Street, Ann Arbor, MI 48105 USA
| | - Chamisa K Mackenzie
- 1Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, 1000 Wall Street, Ann Arbor, MI 48105 USA
| | - Kenneth Resnicow
- 2Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI 48105 USA
| | - Paul P Lee
- 1Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, 1000 Wall Street, Ann Arbor, MI 48105 USA
| | - David C Musch
- 1Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, 1000 Wall Street, Ann Arbor, MI 48105 USA.,3Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48105 USA
| | - Michele Heisler
- 4Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48109 USA
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Bruno M, Wright M, Baker CL, Emir B, Carda E, Clausen M, Sigler C, Patel A. Mobile App Usage Patterns of Patients Prescribed a Smoking Cessation Medicine: Prospective Observational Study. JMIR Mhealth Uhealth 2018; 6:e97. [PMID: 29666043 PMCID: PMC5930175 DOI: 10.2196/mhealth.9115] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 01/30/2018] [Accepted: 02/01/2018] [Indexed: 12/25/2022] Open
Abstract
Background Cigarette smoking is the leading preventable cause of death and is responsible for more than 480,000 deaths per year in the United States. Smoking cessation is challenging for many patients. Regardless of available treatment options, most quit attempts are unaided, and it takes multiple attempts before a patient is successful. With the ever-increasing use of smartphones, mobile apps hold promise in supporting cessation efforts. This study evaluates the ease of use and user satisfaction with the Pfizer Meds app to support smoking cessation among patients prescribed varenicline (Chantix). Objective Study participants included varenicline users who downloaded and used the app on their personal smartphone. The main objectives were to report mobile app download frequency and usage details and to describe the participant-reported satisfaction with and usefulness of the app over the 14-week follow-up study period. Methods Adults aged 18 years or older who had been prescribed varenicline were identified from the Express Scripts Incorporated pharmacy claims database. After meeting privacy restrictions, subjects were sent an invitation letter and second reminder letter with instructions on how to download the Pfizer Meds mobile app. Participants received a push notification to complete a smartphone-enabled survey regarding the utility of the app 12 weeks after downloading the app. Descriptive statistics summarized sociodemographics, use of varenicline, and details of use and satisfaction with the mobile app. Results Of the 38,129 varenicline users who were sent invitation letters, 1281 participants (3.35%) downloaded the Pfizer Meds app. Of the 1032 users with demographic and other data, 585 (56.68%) were females, and 446 (43.22%) were males; mean age was 46.4 years (SD 10.8). The mean number of app sessions per participant was 4.0 (SD 6.8). The end-of-study survey was completed by 131 survey respondents (10.23%, 131/1281); a large number of participants (117/131, 89.3%) reported being extremely, very, or moderately satisfied with the app. A total of 97 survey respondents (97/131, 74.0%) reported setting up a quit date in the app. Of those, 74 (74/97, 76%) reported quitting on their quit date. Conclusions Positive patient engagement was observed in this study based on app download and usage. This study quantified how the Pfizer Meds app performed in an observational real-world data setting. The findings demonstrate the willingness of participants to set a quit date and use the app for support in medication adherence, refill reminders, and information regarding how to take the medication. This study provides real-world evidence of the contribution apps can make to the continued encouragement of smokers to improve their health by smoking cessation.
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Affiliation(s)
| | | | | | | | | | | | | | - Aanal Patel
- Express Scripts Inc, St Louis, MO, United States
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Fajgenbaum M, Ansari E. Prescribing Trends in a Glaucoma Clinic and Adherence to EGS Guidelines: A Retrospective, Non-Interventional, Single-Center UK Study. Adv Ther 2017; 34:2033-2042. [PMID: 28726170 DOI: 10.1007/s12325-017-0593-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The purpose of this study was to determine prescribing trends in a specialist glaucoma clinic in the UK. Specifically, the aims were to determine which drugs were prescribed as first-, second-, and third-line treatment, the persistence of first-, second-, and third-line treatment regimens, and the proportion of treatment decisions conforming to the European Glaucoma Society (EGS) guidelines. METHODS A retrospective, non-interventional, single-center, case-note review was performed on a cohort of consecutive patients presenting to a specialist glaucoma clinic for follow-up. Inclusion criteria for the study were (1) a diagnosis of primary open-angle glaucoma or ocular hypertension, (2) glaucoma management entirely within the unit, and (3) minimum of 2 years of follow-up. RESULTS A total of 114 case notes met the inclusion criteria. Mean age was 71 years (range 40-95 years). Mean length of follow-up was 56 months (range 24-180 months). Prostaglandin analogues (PGA) were the most popular first-line treatment in 73% of patients. As second-line treatment, PGA were again the predominant class, prescribed in 87% of cases, whereas beta-blockers (BB) were prescribed in 70% of cases. Carbonic anhydrase inhibitors (CAI) and alpha-2 agonists (AA) were more popular in third-line regimens. Second-line treatment was introduced at a mean of 28.0 months after first-line treatment (range 1-120 months, 95% CI 22.1-33.9 months). Third-line treatment was introduced at a mean of 22.9 months after second-line treatment (range 1-96 months, 95% CI 17.1-28.8 months). Breaches to EGS guidelines were most common for third-line treatment and included duplication of drug classes. DISCUSSION There was a clear hierarchy of PGA as first-line, BB as second-line, while CAI and AA were considered third-line choices. First-line choices were generally in line with EGS guidelines. There was a tendency to breach guidelines by escalating treatment in dual steps rather than single steps (especially in third-line treatment). Combination drops were popular. In third-line treatment there was an increased incidence of prescribing errors. This data is important in terms of informing patients of the expected treatment course, to remind clinicians about best practice, and also to guide comparisons of cost-effectiveness with other treatment modalities.
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Affiliation(s)
| | - Ejaz Ansari
- Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK.
- University of Kent at Canterbury, Canterbury, UK.
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Killeen O, MacKenzie C, Heisler M, Resnicow K, Lee PP, Newman-Casey PA. User-centered Design of the eyeGuide: A Tailored Glaucoma Behavior Change Program. J Glaucoma 2016; 25:815-821. [PMID: 27096721 PMCID: PMC5067955 DOI: 10.1097/ijg.0000000000000431] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE We employed user-centered design to refine a prototype of the eyeGuide, a novel, tailored behavior change program intended to improve medication adherence among glaucoma patients. PATIENTS Glaucoma patients age 40 years and above prescribed ≥1 glaucoma medication were included. METHODS The eyeGuide consists of tailored educational content and tailored testimonials in which patients share how they were able to overcome barriers to improve their medication adherence. A hybrid of semistructured diagnostic and pretesting interviews were used to refine the content of the eyeGuide. Purposeful sampling was used to recruit a study population representative of the glaucoma patient population. Interviews were conducted until thematic saturation was reached. Interviews were audiorecorded and transcribed verbatim. Three researchers analyzed the transcripts, generated a codebook, and identified key themes using NVivo 10.0 to further refine the eyeGuide. RESULTS Twenty-one glaucoma patients were interviewed; mean age 72±12.4 years, 5 (24%) African Americans, 9 (43%) with poor self-reported adherence, 10 (47.6%) age 75 years and above, 10 (47.6%) with poor vision, and 9 (42.9%) women. Qualitative analysis identified 5 important themes for improving glaucoma self-management: social support, patient-provider relationship, medication routine, patients' beliefs about disease and treatment, and eye drop instillation. All participants expressed satisfaction with in-person delivery of the eyeGuide and preferred this to a Web-based module. Participant feedback resulted in revised content. CONCLUSIONS User-centered design generated improvements in the eyeGuide that would not have been possible without patient input. Participants expressed satisfaction with the tailored content.
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Affiliation(s)
- Olivia Killeen
- Department of Ophthalmology & Visual Sciences, University of Michigan Medical School
| | - Chamisa MacKenzie
- School of Public Health, University of Michigan
- School of Social Work, University of Michigan
| | - Michele Heisler
- School of Public Health, University of Michigan
- Department of Internal Medicine, University of Michigan Medical School
| | | | - Paul P. Lee
- Department of Ophthalmology & Visual Sciences, University of Michigan Medical School
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Abdull MM, Chandler C, Gilbert C. Glaucoma, "the silent thief of sight": patients' perspectives and health seeking behaviour in Bauchi, northern Nigeria. BMC Ophthalmol 2016; 16:44. [PMID: 27102524 PMCID: PMC4839108 DOI: 10.1186/s12886-016-0220-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 04/13/2016] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND In Nigeria, glaucoma has a high prevalence and is the second cause of blindness among adults after cataract. People with glaucoma frequently present very late with advanced disease, and acceptance of and adherence to treatment is low. The purpose of the study was to explore how patients' understand and respond to glaucoma in order develop an intervention to improve adherence to treatment. METHOD Hospital based qualitative study. Six focus group discussions were held with patients with advanced disease and who had either undergone glaucoma surgery, were receiving medical treatment, or had neither surgery nor medical treatment. Two traditional healers who treat eye conditions were interviewed. Audio files were transcribed, translated into English and recurring themes coded and categorized as the impact of vision loss, and understandings of the disease and its management. RESULTS Visual loss impacted significantly on the lives of people with glaucoma in many ways. Many heard the term "glaucoma" for the first time during the study. Local terms to describe the symptoms included Hawan jinin ido ("hypertension of the eye"). Patients sought treatment in pharmacies, or with traditional healers who had different interpretations of glaucoma and its treatment to biomedical understandings. Cost and forgetfulness were the main reasons for low adherence to treatment while fear was a reason for not accepting surgery. Lack of money and negative staff attitudes were reasons for low follow up. CONCLUSION Halting the progression of glaucoma is possible with treatment but the condition will remain a "silent thief of sight" in West Africa unless awareness, uptake of services and adherence to treatment improve. Understanding how glaucoma is locally conceptualised, lived with and responded to by patients is essential to aid the design of interventions to prevent glaucoma blindness in Africa. Findings have been used to adapt a motivational interviewing intervention, which is being evaluated in a clinical trial.
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Affiliation(s)
- Mohammed Mahdi Abdull
- />Ophthalmology Department, Abubakar Tafawa Balewa University Teaching Hospital, PMB 0117, Bauchi, Bauchi State Nigeria
- />International Centre for Eye Health, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Clare Chandler
- />Department of Global Health and Development London School of Hygiene & Tropical Medicine, London, UK
| | - Clare Gilbert
- />International Centre for Eye Health, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
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Pizzi LT, Tran J, Shafa A, Waisbourd M, Hark L, Murchison AP, Dai Y, Mayro EL, Haller JA. Effectiveness and Cost of a Personalized Reminder Intervention to Improve Adherence to Glaucoma Care. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2016; 14:229-40. [PMID: 26924099 DOI: 10.1007/s40258-016-0231-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Glaucoma is the leadi ng cause of irreversible blindness in the USA. Glaucomatous vision loss is preventable with proper eye care, including appointment adherence. Therefore, interventions that improve appointment adherence can reduce the number of patients with more severe glaucoma. OBJECTIVES The primary study aim was to determine the efficacy and cost-effectiveness of a multifaceted personal reminder intervention, which included a customized letter and personal telephone outreach, in improving appointment adherence of patients with glaucoma. A secondary study aim was to identify patient characteristics that were associated with non-adherence. METHODS This prospective, randomized, controlled study included a cost-effectiveness analysis completed using a decision analytic model. The subjects included 256 patients with glaucoma. Study measures included appointment adherence and incremental cost effectiveness ratios. RESULTS Patients in the intervention group were more likely to adhere to appointments (82.31 vs. 69.05 %; RR 1.23; 95 % CI 1.04-1.37, p < 0.012) than patients in the usual care group. Patients in the intervention group were 23 % more likely to adhere to appointments (RR 1.23; 95 % CI 1.08-1.41, p < 0.0021) than patients in the usual care group, when adjusting for age, secondary insurance, primary open angle glaucoma diagnosis, number of previous visits at Wills Eye Hospital, and follow-up recommendation using Poisson regression. Per-patient cost of the program was US$11.32, and cost per follow-up attended within the adherence window was US$73.56. CONCLUSIONS A low cost reminder intervention consisting of a personalized letter and telephone outreach significantly improved appointment adherence of patients with glaucoma.
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Affiliation(s)
- Laura T Pizzi
- Thomas Jefferson University, 901 Walnut Street, Room 911, Philadelphia, PA, 19107, USA.
| | - Judie Tran
- Wills Eye Hospital Glaucoma Research Center, 840 Walnut Street Suite 1140, Philadelphia, PA, USA
| | - Anousheh Shafa
- Wills Eye Hospital Glaucoma Research Center, 840 Walnut Street Suite 1140, Philadelphia, PA, USA
| | - Michael Waisbourd
- Wills Eye Hospital Glaucoma Research Center, 840 Walnut Street Suite 1140, Philadelphia, PA, USA
| | - Lisa Hark
- Wills Eye Hospital Glaucoma Research Center, 840 Walnut Street Suite 1140, Philadelphia, PA, USA
| | - Ann P Murchison
- Wills Eye Hospital Glaucoma Research Center, 840 Walnut Street Suite 1140, Philadelphia, PA, USA
| | - Yang Dai
- Wills Eye Hospital Glaucoma Research Center, 840 Walnut Street Suite 1140, Philadelphia, PA, USA
| | - Eileen L Mayro
- Wills Eye Hospital Glaucoma Research Center, 840 Walnut Street Suite 1140, Philadelphia, PA, USA
| | - Julia A Haller
- Wills Eye Hospital, 840 Walnut Street Suite 1500, Philadelphia, PA, 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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Djafari F, Lesk MR, Giguère CÉ, Siam G, Freeman EE. Impact of a Brief Educational Intervention on Glaucoma Persistence: A Randomized Controlled Clinical Trial. Ophthalmic Epidemiol 2015; 22:380-6. [DOI: 10.3109/09286586.2015.1083036] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Osman EA, Alqarni BAM, AlHasani SSH, Al Harbi SSS, Gikandi PW, Mousa A. Compliance of Glaucoma Patients to Ocular Hypotensive Medications Among the Saudi Population. J Ocul Pharmacol Ther 2015; 32:50-4. [PMID: 26600401 DOI: 10.1089/jop.2015.0052] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To evaluate the compliance of glaucoma patients to medical treatment and its impact on the intraocular pressure (IOP) and to verify the associated risk factors for noncompliance. METHODS All recruited patients were examined at the ophthalmology clinics of King Abdulaziz University Hospital, Riyadh, Saudi Arabia between May and August 2012. Patients were interviewed and subjected to answer a questionnaire that was developed based on a pilot test. Collected data included age, gender, number of prescribed drugs, and different reasons for noncompliance to the prescribed drugs. RESULTS Noncompliance was detected in 18 (19.4%) of the recruited patients. Factors associated with noncompliance demonstrated a trend toward older patients, males, patients with lower IOP at presentation, higher cup to disc ratio, and drug self-administering patients. However, the only statistically significant characteristic was being under lifelong medications (P = 0.005). CONCLUSION Noncompliance was detected in around one-fifth of our glaucoma patients, particularly, the older group. Awareness programs, maintaining good patient-physician relationship, and personalizing treatment can lead to better adherence to treatment.
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Affiliation(s)
- Essam A Osman
- 1 Department of Ophthalmology, College of Medicine, King Saud University , Riyadh, Saudi Arabia
| | | | | | | | | | - Ahmed Mousa
- 1 Department of Ophthalmology, College of Medicine, King Saud University , Riyadh, Saudi Arabia
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Rosdahl JA, Muir KW. Finding the best glaucoma questionnaire: a qualitative and quantitative evaluation of glaucoma knowledge assessments. Clin Ophthalmol 2015; 9:1845-52. [PMID: 26491245 PMCID: PMC4599146 DOI: 10.2147/opth.s90332] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective The goal of the study was to determine which glaucoma quiz provides the best information about patient glaucoma knowledge to clinicians in clinical practice settings. Methods Four glaucoma quizzes were identified from the literature and national eye education programs and were qualitatively analyzed to categorize questions by topic. Quizzes were assessed by 64 glaucoma specialists using an online survey, with descriptive statistics. Comments about the quizzes were analyzed qualitatively using themes and representative quotations. Results Quizzes covered content that was important for glaucoma diagnosis and management. The National Eye Health Education Program (NEHEP) and Prevent Blindness America quizzes covered primarily diagnosis, screening, and risk factors, and the quizzes from the literature primarily covered causes of glaucoma, vision loss, eye drops, and systemic disease. Overall, the NEHEP quiz was ranked best for clinical practice, ranked first by 38%. Ranked second overall, the Gray quiz was ranked first by 34% and last by 34%. Conclusion The NEHEP quiz was rated most useful for assessing baseline general glaucoma knowledge for a busy clinical practice. The Gray quiz appears to be more useful as part of a comprehensive education program, perhaps in combination with an ophthalmic educator.
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Affiliation(s)
| | - Kelly W Muir
- Department of Ophthalmology, Duke University, Durham, NC, USA ; Health Services Research and Development, Durham Veterans Affairs Medical Center, Durham, NC, USA
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Geboers B, Brainard JS, Loke YK, Jansen CJM, Salter C, Reijneveld SA, de Winter AF, deWinter AF. The association of health literacy with adherence in older adults, and its role in interventions: a systematic meta-review. BMC Public Health 2015; 15:903. [PMID: 26377316 PMCID: PMC4573285 DOI: 10.1186/s12889-015-2251-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 09/08/2015] [Indexed: 12/14/2022] Open
Abstract
Background Low health literacy is a common problem among older adults. It is often suggested to be associated with poor adherence. This suggested association implies a need for effective adherence interventions in low health literate people. However, previous reviews show mixed results on the association between low health literacy and poor adherence. A systematic meta-review of systematic reviews was conducted to study the association between health literacy and adherence in adults above the age of 50. Evidence for the effectiveness of adherence interventions among adults in this age group with low health literacy was also explored. Methods Eight electronic databases (MEDLINE, ERIC, EMBASE, PsycINFO, CINAHL, DARE, the Cochrane Library, and Web of Knowledge) were searched using a variety of keywords regarding health literacy and adherence. Additionally, references of identified articles were checked. Systematic reviews were included if they assessed the association between health literacy and adherence or evaluated the effectiveness of interventions to improve adherence in older adults with low health literacy. The AMSTAR tool was used to assess the quality of the included reviews. The selection procedure, data-extraction, and quality assessment were performed by two independent reviewers. Seventeen reviews were selected for inclusion. Results Reviews varied widely in quality. Both reviews of high and low quality found only weak or mixed associations between health literacy and adherence among older adults. Reviews report on seven studies that assess the effectiveness of adherence interventions among low health literate older adults. The results suggest that some adherence interventions are effective for this group. The interventions described in the reviews focused mainly on education and on lowering the health literacy demands of adherence instructions. No conclusions could be drawn about which type of intervention could be most beneficial for this population. Conclusions Evidence on the association between health literacy and adherence in older adults is relatively weak. Adherence interventions are potentially effective for the vulnerable population of older adults with low levels of health literacy, but the evidence on this topic is limited. Further research is needed on the association between health literacy and general health behavior, and on the effectiveness of interventions. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2251-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bas Geboers
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, FA10, PO Box 196, , 9700 AD, Groningen, The Netherlands.
| | - Julii S Brainard
- Norwich Medical School, Faculty of Medicine & Health Sciences, University of East Anglia, Norwich, UK.
| | - Yoon K Loke
- Norwich Medical School, Faculty of Medicine & Health Sciences, University of East Anglia, Norwich, UK.
| | - Carel J M Jansen
- Department of Communication and Information Studies, Faculty of Arts, University of Groningen, Groningen, The Netherlands.
| | - Charlotte Salter
- Norwich Medical School, Faculty of Medicine & Health Sciences, University of East Anglia, Norwich, UK.
| | - Sijmen A Reijneveld
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, FA10, PO Box 196, , 9700 AD, Groningen, The Netherlands.
| | - Andrea F de Winter
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, FA10, PO Box 196, , 9700 AD, Groningen, The Netherlands.
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