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T. A. Gray, C. Fenerty, R. Harper, A. Lee, F. Spencer, M. Campbell, D. B. Henson, H. Waterman; Impact of Individualised Care on Persistence of and Adherence to Ocular Hypotensive Therapy: An Exploratory Randomised Controlled Trial. Invest. Ophthalmol. Vis. Sci. 2010;51(13):200.
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A two-year exploratory randomised controlled trial with a one-year follow-up aimed to improve persistence of and adherence to ocular hypotensive therapy by evaluating individualised care, based on patients’ needs and beliefs about their condition and medication.
Consecutive patients, newly diagnosed with ocular hypertension or open angle glaucoma, were randomised to receive either individualised or usual care. Clinicians, the researcher and outcome assessor were masked to allocations. The intervention was delivered via face-to-face and telephone consultations following an assessment of needs and beliefs. Persistence was measured by collating prescription and dispensing data. Questionnaires were used at exit interview to measure self-reported adherence, knowledge of glaucoma, patient beliefs (The Revised Illness Perception Questionnaire and The Beliefs about Medicines Questionnaire) and enablement (The Patient Enablement Instrument).
One hundred and twenty-seven patients were recruited (intervention group n=64, control group n=63). Patient characteristics were similar at baseline (mean age 66.3 yrs, SD 12.5, 50.4% male). Intention to treat analysis found persistence to be significantly better in the intervention group (70% vs 43%, Χ2 = 9.75, df = 1, p = 0.002). Adherence was also found to be significantly better in the intervention group for patients who forgot drops (Mann-Whitney Z = -6.82, p < 0.001) and those who intentionally missed drops (Mann-Whitney Z = -4.66, p < 0.001). Intervention-arm patients were significantly more knowledgeable about glaucoma (Mann-Whitney Z = -6.73 p < 0.001), expressed a significantly stronger belief in the necessity of eye drops (Mann-Whitney Z = -5.58, p < 0.001) and believed they had more personal control over managing their condition (Mann-Whitney Z = -4.65, p < 0.001).
This exploratory randomised controlled trial demonstrated that modelling patient care according to needs and beliefs about illness and medicines can have a clinically significant impact on improving persistence of and adherence to therapy for this patient group.
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