Abstract
Purpose:
This study aims to compare the impact of traditional counseling versus patient-centered counseling including recorded audio reinforcement on clinical follow-up rates and patient retention of basic glaucoma knowledge.
Methods:
This prospective randomized controlled trial compared three types of glaucoma counseling: (1) traditional counseling which consisted of one-way information sharing, (2) patient-centered counseling which focused on filling in gaps in patient knowledge and empowering patients to understand their disease, and (3) patient-centered counseling with recorded audio information reinforcement. 399 consecutive patients newly diagnosed with glaucomatous disease at the Aravind Eye Hospital glaucoma clinic in South India were enrolled and randomized to receive the either the standard glaucoma counseling or one of the two new methods of patient-centered counseling. All subjects completed an 8-point glaucoma knowledge questionnaire before and after counseling sessions at diagnosis and 1-month follow-up. Patients were advised to return to clinic for routine follow-up and repeat counseling at 1, 3, 6, 9, and 12 months after enrollment. Multivariate logistic regression model was used to determine factors associated with appropriate follow-up, defined as at least 3 follow-up visits. Main outcome measures included Glaucoma Knowledge Assessment Score (GKAS) and the proportion of subjects with adequate follow-up.
Results:
Overall, only 13.5% of the 399 subjects completed the three-visit requirement for appropriate follow-up. There was no significant difference in follow-up rate among the three groups (12.8% with traditional counseling, 11.3% with patient-centered counseling, and 16.5% with patient-centered counseling and audio reinforcement). The mean GKAS improved an average of 77.6% with counseling and did not differ amongst the three groups (p<0.0001). While the GKAS gradually decreased with time and increased with repeat counseling, no difference in this parameter was found between groups at any time point.
Conclusions:
While initial and repeat patient-centered counseling significantly improved patient knowledge regarding glaucomatous disease and the importance of appropriate follow-up, the majority of newly diagnosed glaucoma patients did not return for care, suggesting that factors other than disease information likely impact adherence to appropriate follow-up schedules.