Individualised patient care as an adjunct to standard care for promoting adherence to ocular hypotensive therapy: an exploratory randomised controlled trial

Abstract

Purpose To evaluate the impact of individualised patient care, as an adjunct to standard care, on adherence to ocular hypotensive therapy. Methods A two-arm, single-masked exploratory randomised controlled trial recruited patients newly prescribed ocular hypotensive therapy. The intervention involved an individual assessment of health-care needs and beliefs and a 1-year follow-up period according to need. The primary outcome was refill adherence, measured by collating prescription and dispensing data for 12 months. Secondary outcomes included self-reported adherence, glaucoma knowledge, beliefs about illness and medicines, quality of care, intraocular pressure (IOP) fluctuation, and changes in clinical management assessed at 12 months. The strength of the intervention was measured following withdrawal by reviewing clinical outcomes for a further 12 months. Results In all, 127 patients were recruited (91% response rate). Intervention-arm patients collected significantly more prescriptions than control-arm patients. Self-report adherence was significantly better in the intervention-arm for patients who forgot drops and those who intentionally missed drops. The intervention group demonstrated significantly more glaucoma knowledge, expressed a significantly stronger belief in the necessity of eye drops and believed that they had more personal control over managing their condition. Control-arm patients had more IOP fluctuation and changes in clinical management. However, this finding only reached significance at 24 months. Conclusion Modelling patient care according to health-care needs and beliefs about illness and medicines can have a significant impact on improving adherence to therapy for this patient group, with the potential benefit of improving clinical outcomes.

Impact of Patient-Held Record on Knowledge at 1-Year Follow-Up for Glaucoma Patients: Single-Center Randomized Controlled Trial

“…Previous research recognizes that clients who receive emotional support and information at the initial diagnosis of glaucoma benefit by subsequently displaying good compliance and cooperation with their care (7,8). The NICE Guideline Development Group made recommendations for research into the clinical effectiveness of providing people with glaucoma with a glaucoma personal record (GPR) and for this to be compared to standard treatment (9).…”

Systematic review of educational interventions to improve glaucoma medication adherence: an update in 2015

“…In the UK, Gray and colleagues 17 randomized 127 newly diagnosed patients with ocular hypertension or open angle glaucoma from a single eye hospital in England to a personalized individual healthcare assessment in addition to standard care or standard care with an ophthalmologist. The intervention began with a 75 minute counseling session with a glaucoma nurse to design a one year personalized follow-up plan.…”

“…Overall, five out of the nine RCTs used electronic medication monitoring. 14,16,20,21,22 Two RCTs, Gray's study 17 of individualized counseling with a glaucoma nurse and Muir's of education tailored to health literacy, used medication refill data. This is also a widely accepted measure of medication adherence.…”

Pharmacotherapy and Adherence Issues in Treating Elderly Patients with Glaucoma

“…However, studies using multifaceted intervention components including education and discussing strategies for incorporating medication administration into their daily activities have detected a significant improvement in adherence [138,139]. Patients who have a stronger belief in the necessity for eye drops are more adherent [140], and studies that have targeted patient beliefs have been effective in improving adherence [141,142]. The study by Gray and co-workers found a positive improvement in adherence to glaucoma medication using an individualised patient care programme, which included education and training with the patient and their informal caregivers [142].…”

“…Patients who have a stronger belief in the necessity for eye drops are more adherent [140], and studies that have targeted patient beliefs have been effective in improving adherence [141,142]. The study by Gray and co-workers found a positive improvement in adherence to glaucoma medication using an individualised patient care programme, which included education and training with the patient and their informal caregivers [142]. Whilst it is not possible to ascertain the individual components of the complex intervention that may have improved adherence behaviour, modelling patient care according to the healthcare needs and beliefs about medicines could hold the key to the design of future interventions.…”