Integrating Patient Education Into the Glaucoma Clinical Encounter: A Lean Analysis

Newman-Casey, Paula Anne; Musser, John A; Niziol, Leslie M.; Heisler, Michele; Kamat, Shivani; Shah, Manjool; Patel, Nish; Cohn, Amy M.

doi:10.1097/ijg.0000000000001192

Cited by 8 publications

(3 citation statements)

References 34 publications

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“…In our trial, physician time per patient in the control arm was 3.04 minutes (vs. about 8–10 minutes in US-based glaucoma studies [ 36 , 37 ]). The dramatically lower time per patient at our trial site reflects AECS’s design philosophy: senior doctors perform only those tasks that cannot be performed by junior doctors or other staff [ 38 ].…”

Section: Discussionmentioning

confidence: 67%

Evidence from the first Shared Medical Appointments (SMAs) randomised controlled trial in India: SMAs increase the satisfaction, knowledge, and medication compliance of patients with glaucoma

Sönmez

Srinivasan

Venkatesh

et al. 2023

PLOS Glob Public Health

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In Shared Medical Appointments (SMAs), patients with similar conditions meet the physician together and each receives one-on-one attention. SMAs can improve outcomes and physician productivity. Yet privacy concerns have stymied adoption. In physician-deprived nations, patients’ utility from improved access may outweigh their disutility from loss of privacy. Ours is to our knowledge the first SMA trial for any disease, in India, where doctors are scarce. In a 1,000-patient, single-site, randomized controlled trial at Aravind Eye Hospital, Pondicherry, we compared SMAs and one-on-one appointments, over four successive visits, for patients with glaucoma. We examined patients’ satisfaction, knowledge, intention-to-follow-up, follow-up rates, and medication compliance rates (primary outcomes) using intention-to-treat analysis. Of 1,034 patients invited between July 12, 2016 –July 19, 2018, 1,000 (96.7%) consented to participate, and were randomly assigned to either SMAs (NSMA = 500) or one-on-one appointments (N1-1 = 500). Patients who received SMAs showed higher satisfaction (MeanSMA = 4.955 (SD 0.241), Mean1-1 = 4.920 (SD 0.326); difference in means 0.035; 95% CI, 0.017–0.054, p = 0.0002) and knowledge (MeanSMA = 3.416 (SD 1.340), Mean1-1 = 3.267 (SD 1.492); difference in means 0.149; 95% CI, 0.057–0.241, p = 0.002) than patients who received one-on-one appointments. Across conditions, there was no difference in patients’ intention-to-follow-up (MeanSMA = 4.989 (SD 0.118), Mean1-1 = 4.986 (SD 0.149); difference in means 0.003; 95% CI, -0.006–0.012, p = 0.481) and actual follow-up rates (MeanSMA = 87.5% (SD 0.372), Mean1-1 = 88.7% (SD 0.338); difference in means -0.012; 95% CI, -0.039–0.015, p = 0.377). Patients who received SMAs exhibited higher medication compliance rates (MeanSMA = 97.0% (SD 0.180), Mean1-1 = 94.9% (SD 0.238); difference in means 0.020; 95% CI, 0.004–0.036, p = 0.013). SMAs improved satisfaction, learning, and medication compliance, without compromising follow-up rates or measured clinical outcomes. Peer interruptions were negatively correlated with patient satisfaction in early-trial SMAs and positively correlated with patient satisfaction in later-trial SMAs. Trial registration: The trial was registered with Clinical Trials Registry of India (https://ctri.nic.in/) with reference no. REF/2016/11/012659 and registration no. CTRI/2018/02/011998.

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Section: Discussionmentioning

confidence: 67%

Evidence from the first Shared Medical Appointments (SMAs) randomised controlled trial in India: SMAs increase the satisfaction, knowledge, and medication compliance of patients with glaucoma

Sönmez

Srinivasan

Venkatesh

et al. 2023

PLOS Glob Public Health

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“…The team created a value-stream visual diagram that incorporates every process in the clinic flow. The team then mapped where the “value” and the “waste” occurred and identified potential areas of improvement [ 20 ].…”

Section: Methodsmentioning

confidence: 99%

Measuring impact of a quality improvement initiative on glaucoma clinic flow using an automated real-time locating system

et al. 2022

Self Cite

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Background Lean methodology helps maximize value by reducing waste, first by defining what value and waste are in a system. In ophthalmology clinics, value is determined by the number of patients flowing through the clinic for a given time. We aimed to increase value using a lean-methodology guided policy change, then assessed its impact on clinic flow using an automated radiofrequency identification (RFID) based real-time locating system (RTLS). Methods A total of 6813 clinical visits occurred at a single academic institution’s outpatient glaucoma clinic between January 5, 2018 to July 3, 2018. Over that period, 1589 patients comprising 1972 (29%) of visits were enrolled, with 1031 clinical visits occurring before and 941 visits after a policy change. The original policy was to refract all patients that improved with pinhole testing. The policy change was not to refract patients with a visual acuity ≥20/30 unless a specific request was made by the patient. Pre-post analysis of an automated time-motion study was conducted for the data collected 3 months before and 3 months after the policy change occurred on March 30, 2018. Changes to process and wait times were summarized using descriptive statistics and fitted to linear mixed regression models adjusting for appointment type, clinic volume, and daily clinic trends. Results One thousand nine hundred twenty-three visits with 1588 patients were included in the analysis. Mean [SD] age was 65.9 [14.7] years and 892 [56.2%] were women. After the policy change, technician process time decreased by 2.9 min (p < 0.0001) while daily clinical patient volume increased from 51.9 ± 16.8 patients to 58.4 ± 17.4 patients (p < 0.038). No significant difference was found in total wait time (p = 0.18) or total visit time (p = 0.83). Conclusions Real-time locating systems are effective at capturing clinical flow data and assessing clinical practice change initiatives. The refraction policy change was associated with reduced technician process time and overall the clinic was able to care for 7 more patients per day without significantly increasing patient wait time.

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“…Most studies analyzing the effects of educational interventions on medication adherence have designed interventions focused on eye drop administration technique and patient provider communication by showing patients instructional videos for eye drop administration, 12 videotaping and transcribing clinic visits, 13,14 and assigning trained personnel to counsel patients. 15 Interventions built on patient education and motivational interviewing are hypothesized to have improved glaucoma medication adherence by increasing patient confidence in following medication regimens 14,[16][17][18][19][20] . Carpenter and colleagues found that provider education regarding medication adherence was associated with improved IOP at an eightmonth follow-up.…”

Section: Introductionmentioning

confidence: 99%

Lifestyle Counseling for Medication Adherence in Glaucoma

Kim

Tong

Lee

et al. 2021

OPTH

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Background Medication adherence in glaucoma patients remains sub-par despite proven benefits of regular administration. The objective was to analyze medication adherence before and after lifestyle counseling in patients with ocular hypertension (OHT) or primary open-angle glaucoma (POAG) (mild, moderate, severe). Methods Prospective cohort study from May to July 2018 at a single academic center. From 391 consecutive records, 247 were excluded based on exclusion criteria with 28 patients not meeting inclusion criteria resulting in the final sample of 116 patients (33 had OHT, 83 had POAG – 28 mild, 39 moderate, 16 severe). Scripted lifestyle counseling focusing on diet, exercise, vitamin intake, stress management, and medication adherence was administered by a team of trained medical students. Primary outcome measure was self-reported medication adherence, defined as not missing an eye drop administration in the past month. A 2–3 week follow-up with scripted telephone survey assessing medication adherence, diet, and exercise was collected. Results At baseline, in 116 patients, 59.5% were adherent to their medication with a breakdown of 42.4% OHT, 64.3% mild, 66.7% moderate, and 68.7% severe and an increasing trend in medication adherence was found across increasing disease severity (p=0.055). Of the 76 (65.5%) patients reached for follow-up, 17 (22.4%) became adherent following lifestyle counseling (p=0.02) increasing overall adherence to 78.9% from 62.5%. Conclusion In our study, comprehensive lifestyle counseling succeeded in increasing medication adherence in patients with OHT and POAG.

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Integrating Patient Education Into the Glaucoma Clinical Encounter: A Lean Analysis

Cited by 8 publications

References 34 publications

Evidence from the first Shared Medical Appointments (SMAs) randomised controlled trial in India: SMAs increase the satisfaction, knowledge, and medication compliance of patients with glaucoma

Evidence from the first Shared Medical Appointments (SMAs) randomised controlled trial in India: SMAs increase the satisfaction, knowledge, and medication compliance of patients with glaucoma

Measuring impact of a quality improvement initiative on glaucoma clinic flow using an automated real-time locating system

Lifestyle Counseling for Medication Adherence in Glaucoma

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