Elsevier

Ophthalmology

Volume 116, Issue 12, December 2009, Pages 2286-2293
Ophthalmology

Original article
Interventions Improve Poor Adherence with Once Daily Glaucoma Medications in Electronically Monitored Patients

https://doi.org/10.1016/j.ophtha.2009.05.026Get rights and content

Purpose

To investigate the impact of an intervention program to improve adherence with topical, once daily therapy for glaucoma.

Design

Randomized controlled clinical trial.

Participants

Sixty-six patients with glaucoma being treated with a prostaglandin analog in 1 or both eyes at the Scheie Eye Institute or Wilmer Eye Institute between November 2006 and June 2007.

Methods

In an observational study, participants who took 75% or fewer doses (as measured using the travoprost Dosing Aid [DA]) during an initial 3-month period were randomized into 2 groups. The intervention group watched an educational video, reviewed current barriers to drop-taking and possible solutions with a study coordinator, received regular phone call reminders, and had audible and visible reminders activated on their DA devices. The control group was told to take drops as prescribed and received no additional intervention.

Main Outcome Measures

Change in drop use adherence as determined by the DA device.

Results

In the 3-month observation period before randomization, intervention group patients had used a mean of 54±17% of scheduled doses, and this increased to 73±22% during the following 3-month period (P<0.001, n = 35). The control mean adherence rate of 46±23% at baseline was statistically unchanged during the follow-up observation period (51±30%, P = 0.16, n = 31). In a multivariate analysis, intervention, baseline compliance rate of <50%, and white ethnicity were predictors of improved adherence during the 3 months of intervention. The intraocular pressure (IOP) of the intervention and control groups did not change between months 3 and 6 after intervention (P = 0.96, 0.34, respectively), and there was no correlation of IOP change with adherence rate change between both groups (Pearson correlation r = 0.06, P = 0.51).

Conclusions

A multifaceted intervention significantly increased adherence with glaucoma medications. Those with improved adherence were in the intervention group, had very low adherence rates at baseline, and were white. IOP did not correlate with adherence. Further research is needed to determine which components of this intervention were most effective.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found after the references.

Section snippets

Study Design

Patients were recruited from the Glaucoma Services of the Wilmer Eye Institute and the Scheie Eye Institute. Institutional review boards at both centers approved the study protocol, and written informed consent was obtained from all study patients.

The study had 2 phases. Phase 1 was a prospective, observational cohort study of patient adherence to travoprost therapy for a 3-month interval.14 Because no other bottles for glaucoma medications fit within the Dosing Aid (DA), it can provide data on

Results

Study recruitment for the phase 2 randomized trial began in November of 2006 and ended in June of 2007. Of the 66 patients who were adherent less than 75% of the time, 35 (53%) were randomized to the intervention group and 31 (47%) were randomized to the control group. The intervention and control groups were similar in mean age, race, sex, education level, and income based on zip code (P>0.05 for all; Table 1). The 2 groups also had generally similar ocular characteristics, although the

Discussion

We found that a multifaceted program for enhancing glaucoma eyedrop use improved the adherence rate from 54% to 73% (P<0.001) in persons whose baseline drop-taking was less than 75%. The intervention was administered completely by study staff and did not include physician input with the patient. The intervention was designed to maximize the chance that the adherence with medication use would improve. Our findings suggest that using several approaches at once likely increased the probability

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  • Cited by (0)

    Manuscript no. 2009-53.

    Available online: October 7, 2009.

    Financial Disclosure(s): Supported in part by the National Institutes of Health, Bethesda, Maryland (Clinician—Scientist Training award K12 EY015398 [Dr Okeke]); a grant from The Paul and Evanina Bell Mackall Foundation Trust, New York, New York (Drs Okeke and Ying); the Glaucoma Division, Wilmer Institute research program, Baltimore, Maryland; and unrestricted funds and material support from Alcon, Inc., Fort Worth, Texas.

    Conflict of interest: Drs. Friedman and Quigley are paid consultants for and have received honoraria or research support from Alcon. No conflicting relationship exists for any other authors.

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