Provider Use of Collaborative Goal Setting with Glaucoma Patients

Abstract

Purpose The purpose of this preliminary study was to describe the extent to which providers used collaborative goal setting and individualized assessment with patients who were newly prescribed glaucoma medications. Methods English-speaking glaucoma suspect patients from six ophthalmology clinics who were newly prescribed glaucoma medications had their medical visits video-tape recorded and were interviewed after the visits. The video-tapes were transcribed and coded to examine provider use of collaborative goal setting and individualized assessment. Results Fifty-one patients seeing 12 ophthalmologists participated. Providers gave patients glaucoma treatment options during 37% of the visits; only five providers gave patients treatment options Providers asked for patient treatment preferences in less than 20% of the visits; only two providers asked for patient treatment preferences. Providers were significantly more likely to ask African American patients for their preferences or ideas concerning treatment than non-African American patients (Pearson chi-square= 4.1, p=0.04). Providers were also significantly more likely to ask African American patients about their confidence in using glaucoma medication regularly than non-African American patients (Pearson chi-square=8.2, p=0.004). Providers asked about patient views about glaucoma in less than 20% of the visits; five providers asked patients their views on glaucoma and its treatment. Providers were significantly more likely to ask African American patients about their views of glaucoma than non-African American patients (Pearson chi-square=5.62, p=0.02). Conclusions Eye care providers often did not use collaborative goal setting or conduct individualized assessments of patient views of glaucoma when prescribing treatment for the first time.

Patient and Provider Perspectives on Glaucoma Treatment Adherence: A Delphi Study in Urban Alabama

“… 50 However, such findings stand in contrast with glaucoma research indicating that patients' views and treatment goals may not be adequately explored. 51 Our results highlight the need for providers to remain vigilant for sociobehavioral determinants, particularly because less observable factors such as acute psychological stress have been associated with elevated IOP. 52 …”

Pilot Study of Clinician-Patient Collaboration in Glaucoma

“…13 Clinical clinician-patient communication. 9,[23][24][25] In one report they examined whether specific aspects of clinicianpatient interaction were associated with treatment adherence in the 60 days after the consultation. They found that provider information on how to instil drops was associated with improved adherence, but this information was only given in 14% of visits.…”

“…Fifty-one of the patients in Sleath et al's cohort were commenced on glaucoma treatment for the first time during the videotaped consultations and they concluded that clinicians did not use collaborative goal setting or take into account the individuals' views on glaucoma and its treatment. 9 In only 19 of the 51 (37%) were patients given a treatment choice, and 13 of this 19 involved one clinician. Furthermore, of the 15 physicians who started patients on glaucoma treatment during this study, only 5 (33%) gave treatment choices.…”

“…The nature of glaucoma, however, means that major treatment decisions are not required at most consultations, and therefore we felt these methods of assessment were not likely to be useful in this study. We, therefore, set the criteria for assessment based on the previous studies in this subject in glauc [9][10][11] We recorded the following information:-…”

“…Research into CDM in ophthalmology is, however, very limited, and the small number of studies looking at this area in glaucoma has suggested that there is room for improvement. [9][10][11] There is evidence from other areas of medicine that patient-clinician collaboration can be improved using interventions targeted at both patients and clinicians. 12 We are keen to test such interventions in glaucoma but with such a limited evidence base in ophthalmology with which to justify funding and plan study protocols, we decided to undertake a pilot study to determine the feasibility of such a study.…”