Abstract
Purpose :
Interventions for improving medication adherence in glaucoma have had equivocal results due in part to a lack of stakeholder input. Incorporating patient and provider perspectives into intervention design may improve their ability to target key determinants of adherence. We assessed the perceived utility of the most effective interventions identified in the literature by sampling perspectives of glaucoma patients and providers.
Methods :
We performed a literature review to identify studies that delivered interventions for improving adherence, and included only studies that used electronic monitoring and had at least three months of follow-up. We categorized the interventions based on the strategies delivered: education, reminders, motivational interviewing (MI), health coaching, instillation skill training, and combination vs polytherapy. We invited patients and providers to assess the utility of each strategy in day-to-day glaucoma management using a 4-point Not Useful to Very Useful Likert scale. We also used the Glaucoma Treatment Compliance Assessment Tool to assess patients’ perceived glaucoma severity, susceptibility, treatment benefits, treatment barriers, and glaucoma knowledge. Patients (n = 13) were above age 40, used ocular hypotensive eyedrops, and had glaucoma for at least 2 years. Providers (n = 5) were optometrists or ophthalmologists who had at least 2 years’ experience treating glaucoma.
Results :
Only four strategies—education, reminders, MI, and health coaching led to a significant increase in adherence. For patients, education (median, IQR = 4.0, 0.25), health coaching (3.0, 1.0), and reminders (3.0, 2.0) had the highest utility, compared to MI (4.0, 0), reminders (3.7, 0.33), and education (3.5, 0.25) among providers. Higher glaucoma knowledge was associated with a preference for education (rho = .603, p = .03), and higher perceived glaucoma severity was associated with a preference for reminders (rho = .626, p = .02), instillation skill training (rho = .754, p = .003), and MI (rho = .754, p = .003).
Conclusions :
The most effective strategies based on empirical data—education, reminders, MI, and health coaching—had the highest perceived utility in day-to-day management of glaucoma. Incorporating patient and provider perspectives into intervention design may improve their uptake and effectiveness, ultimately resulting in improved medication adherence in glaucoma.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.