Ophthalmologist–Patient Communication, Self-efficacy, and Glaucoma Medication Adherence

Sleath, Betsy; Blalock, Susan J.; Carpenter, Delesha M.; Sayner, Robyn; Muir, Kelly W.; Slota, Catherine; Lawrence, Scott D.; Giangiacomo, Annette; Hartnett, M. Elizabeth; Tudor, Gail; Goldsmith, J.; Robin, Alan L.

doi:10.1016/j.ophtha.2014.11.001

Cited by 102 publications

(71 citation statements)

References 38 publications

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“…First, information on the purpose of using glaucoma eye drops, the importance of adhering to the prescribed regimen, or the frequency with which to administer drops might be inadequately communicated to or misunderstood by the patient. 39 As a result, the patient may self-administer their medications less frequently than prescribed while genuinely believing that they are taking their medications as their provider prescribed. Furthermore, some patients may have felt the need to please the research assistant during the interview by stating better adherence than actuality (i.e.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of Patient-reported Adherence to Glaucoma Medications on a Visual Analog Scale Compared With Electronic Monitors

Sayner

Carpenter

Blalock

et al. 2015

Clinical Therapeutics

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Purpose Glaucoma medications can reduce intraocular pressure and improve clinical outcomes when patients adhere to their medication regimen. Providers often ask glaucoma patients to self-report their adherence, but the accuracy of this self-report method has received little scientific attention. Our purpose was to compare a self-report medication adherence measure with adherence data collected from Medication Event Monitoring Systems (MEMS) electronic monitors. Additionally, we sought to identify which patient characteristics were associated with over-reporting adherence on the self-reported measure. Methods English-speaking adult glaucoma patients were recruited for this observational cohort study from six ophthalmology practices. Patients were interviewed immediately after a baseline medical visit and were given MEMS containers, which were used to record adherence over a 60-day period. MEMS data were used to calculate percent adherence, which measured the percentage of the prescribed number of doses taken, and timing adherence, which assessed the percent doses taken on time. Patients self-reported adherence to their glaucoma medications on a visual analog scale (VAS) approximately 60 days following the baseline visit. Bivariate analyses and logistic regressions were used to analyze the data. Self-reported medication adherence on the VAS was plotted against MEMS adherence to illustrate the level of discrepancy between self-reported and electronically-monitored adherence. Findings The analyses included 240 patients who returned their MEMS containers and who self-reported medication adherence at the 60-day follow-up visit. When compared with MEMS-measured percent adherence, 31% of patients (n=75) over-estimated their adherence on the VAS. When compared with MEMS-measured timing adherence, 74% (n=177) of patients over-estimated their adherence on the VAS. For the MEMS-measured percent adherence, logistic regression revealed that patients who were newly prescribed glaucoma medications were significantly more likely to over-report adherence on the VAS (OR=3.07, 95% CI: 1.22, 7.75). For the MEMS–measured timing adherence, being male (chi-square=6.78, p=0.009) and being prescribed glaucoma medications dosed multiple times daily (chi-square =4.02, p=0.045) were significantly associated with patients over-reporting adherence on the VAS. However, only male gender remained a significant predictor of over-reporting adherence in the logistic regression, (OR=4.05, 95% CI: 1.73, 9.47). Implications Many glaucoma patients, especially new patients, over-estimated their medication adherence. Because patients were likely to over-report percent doses taken and timing adherence, providers may want to ask patients additional questions about when they take their glaucoma medications in order to potentially detect issues with taking glaucoma medications on time.

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Section: Discussionmentioning

confidence: 99%

Accuracy of Patient-reported Adherence to Glaucoma Medications on a Visual Analog Scale Compared With Electronic Monitors

Sayner

Carpenter

Blalock

et al. 2015

Clinical Therapeutics

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“…9 Although numerous factors affect adherence, self-efficacy is a patient-level factor that has consistently predicted patient adherence in chronic diseases generally 10–12 and glaucoma specifically. 13–15 …”

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confidence: 99%

Communication Predicts Medication Self-Efficacy in Glaucoma Patients

Carpenter¹,

Blalock²,

Sayner³

et al. 2016

Optom Vis Sci

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Purpose Medication self-efficacy, or patients’ confidence that they can perform medication-related behaviors, is associated with better glaucoma medication adherence. Little is known about how to enhance glaucoma patients’ medication self-efficacy. Our purpose is to examine whether patient-provider communication increases glaucoma patients’ medication self-efficacy. Methods During an 8-month cohort study of 279 glaucoma patients and 15 providers, two office visits were videotape-recorded, transcribed, and coded for six patient-provider communication behaviors. A validated scale was used at baseline and 8-month follow-up to assess patients’ confidence in overcoming adherence barriers (adherence barriers self-efficacy) and carrying out tasks to use eye drops correctly (eye drop task self-efficacy). We ran two generalized estimating equations to examine whether more frequent patient-provider communication during office visits predicted increased patient adherence barriers self-efficacy and eye drop task self-efficacy at 8-month follow-up. Results For each additional topic providers educated about, patients reported an average increase of 0.35 in self-efficacy in overcoming adherence barriers (p<0.001). Patients also reported an average increase of 1.01 points in eye drop task self-efficacy when providers asked about patients’ views of glaucoma and its treatment versus not (p<0.001). Patients who asked more medication questions (p<0.001) and African American patients (p<0.05) reported lower adherence barriers self-efficacy by 0.30 and 2.15 points, respectively. Women had a 0.63 lower eye drop task self-efficacy than men (p<0.05). Conclusions When providers educate glaucoma patients and assess patient views about glaucoma and its treatment, patients report higher medication self-efficacy. Providers should be aware that patients who ask more medication questions may have less confidence in their ability to overcome barriers to adherence.

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“…17 Patients were eligible for the primary study if they were ≥ 18 years of age, had a diagnosis of glaucoma, were mentally competent to participate and were not blind in both eyes (no light perception). Provider and patient consents were obtained for the primary investigation after the study was explained.…”

Section: Methodsmentioning

confidence: 99%

Patient-Physician Communication on Medication Cost during Glaucoma Visits

et al. 2017

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Significance This paper is the first to investigate the nature of medication cost discussions between ophthalmologists and glaucoma patients. Only 87 of the 275 office visits analyzed had a discussion of medication cost. Providers should consider discussing medication cost with patients to identify potential cost related barriers to medication use. Purpose Glaucoma is an incurable chronic eye disease affecting a growing portion of the aging population. Some of the most commonly utilized treatments require life-long use, requiring high patient adherence to ensure effectiveness. There are numerous barriers to glaucoma treatment adherence in the literature, including cost. The aim of this secondary analysis was to describe the frequency and nature of patient-physician communication regarding medication cost during glaucoma office visits. Methods: This was a mixed methods secondary analysis of video recorded participant office visits (n=275) from a larger observational study of glaucoma communication. We analyzed medical information, demographic characteristics, and interviewer-administrated questionnaires, as well as verbatim transcripts of interviews. Results Only 87 participants discussed medication cost during their glaucoma office visit. The majority of the subjects that discussed cost had mild disease severity (51%), took one glaucoma medication (63%) and had Medicare (49%) as well as a form of prescription insurance (78%). The majority of glaucoma office visits did not discuss medication cost and providers often did not ask about cost problems. Of the few conversations related to cost, most focused on providers offering potential solutions (n=50), medical and prescription service coverage (n=41), and brand or generic medication choices (n=41). Conclusions Our findings are similar to previous studies showing few patients have conversations with providers about the cost of glaucoma medications. Providers should consider bringing up medication cost during glaucoma office visits to prompt a discussion of potential cost related barriers to medication use.

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Ophthalmologist–Patient Communication, Self-efficacy, and Glaucoma Medication Adherence

Cited by 102 publications

References 38 publications

Accuracy of Patient-reported Adherence to Glaucoma Medications on a Visual Analog Scale Compared With Electronic Monitors

Accuracy of Patient-reported Adherence to Glaucoma Medications on a Visual Analog Scale Compared With Electronic Monitors

Communication Predicts Medication Self-Efficacy in Glaucoma Patients

Patient-Physician Communication on Medication Cost during Glaucoma Visits

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