The eyeGuide: Improving Glaucoma Self-management With a Personalized Behavior Change Program
Status: | Active, not recruiting |
---|---|
Conditions: | Ocular |
Therapuetic Areas: | Ophthalmology |
Healthy: | No |
Age Range: | 40 - Any |
Updated: | 10/26/2018 |
Start Date: | January 12, 2017 |
End Date: | October 12, 2020 |
The purpose of this research study is to test the impact of two personalized technology based
programs that may help improve adherence to glaucoma medications.
programs that may help improve adherence to glaucoma medications.
Despite evidence from randomized clinical trials that medication reduces vision loss from
glaucoma, it remains the second leading cause of blindness in the United States. A critical
barrier to preventing vision loss is that about one-half of glaucoma patients are essentially
"untreated" because they do not adhere to their medications. Ineffective self-management
behaviors and poor clinical outcomes disproportionately affect the most vulnerable members of
US society. The increased burden of glaucoma due to an aging US population, together with a
projected shortage of ophthalmologists, will make team-based care essential. There is a
critical need to develop and test team-based, personalized behavior change interventions for
glaucoma patients to improve medication adherence and the outcomes of care.
Poor adherence to effective medications is a critical barrier to better outcomes in glaucoma
patients. The World Health Organization stated that "increasing the effectiveness of
adherence interventions may have a far greater impact on the health of the population than
any improvement in specific medical treatments." Once diagnosed with glaucoma, at least half
of patients do not adhere to their glaucoma medication regimen, return for follow-up, or
persist with their medications over the longer term. Patients who are not adherent have more
severe visual field loss, which leads to steep declines in health-related quality of life and
increased risk of falls and motor vehicle accidents.
Adherence to glaucoma medications is rarely addressed during the clinical encounter because
education and counseling programs are not part of standard glaucoma care. Focus groups have
demonstrated that patients often have a poor understanding of glaucoma and its treatment. In
addition to knowledge gaps, patients have numerous concrete and psychological barriers to
managing their glaucoma. In addition, eye drop instillation is rarely taught, and many
patients cannot properly instill their medications.
Uniform, scripted approaches to improve adherence do not work. However, complex,
individualized counseling interventions, especially those based in motivational interviewing
(MI), have improved adherence and health outcomes in many chronic diseases. MI is a style of
counseling that engages patients by discussing priorities and obstacles to facilitate
intrinsic motivation to change health behavior. Few complex interventions based on these
successful principles have been rigorously tested and none implemented into glaucoma care.
The eyeGuide is a web-based personally tailored behavior change program based on MI
principles, a systematic review of the glaucoma adherence literature, and data from focus
groups, surveys and iterative beta-testing with glaucoma patients. It provides individually
tailored disease information and support to facilitate MI-based conversations between
patients and paraprofessional staff to improve medication adherence. Such technology-based
electronic health (eHealth) innovations have great potential to extend the reach of
physicians by enabling team-based care.
In this pilot study, the study will test the impact of two personalized eHealth technologies
on medication adherence among non-adherent glaucoma patients in a pre-post design: 1) real
time automated adherence reminders; and 2) the eyeGuide counseling program. The study will
explore the effects of these interventions on secondary outcomes including psychosocial
mediators of adherence (e.g. motivation, self-efficacy, satisfaction), intraocular pressure
(IOP), and IOP fluctuation.
glaucoma, it remains the second leading cause of blindness in the United States. A critical
barrier to preventing vision loss is that about one-half of glaucoma patients are essentially
"untreated" because they do not adhere to their medications. Ineffective self-management
behaviors and poor clinical outcomes disproportionately affect the most vulnerable members of
US society. The increased burden of glaucoma due to an aging US population, together with a
projected shortage of ophthalmologists, will make team-based care essential. There is a
critical need to develop and test team-based, personalized behavior change interventions for
glaucoma patients to improve medication adherence and the outcomes of care.
Poor adherence to effective medications is a critical barrier to better outcomes in glaucoma
patients. The World Health Organization stated that "increasing the effectiveness of
adherence interventions may have a far greater impact on the health of the population than
any improvement in specific medical treatments." Once diagnosed with glaucoma, at least half
of patients do not adhere to their glaucoma medication regimen, return for follow-up, or
persist with their medications over the longer term. Patients who are not adherent have more
severe visual field loss, which leads to steep declines in health-related quality of life and
increased risk of falls and motor vehicle accidents.
Adherence to glaucoma medications is rarely addressed during the clinical encounter because
education and counseling programs are not part of standard glaucoma care. Focus groups have
demonstrated that patients often have a poor understanding of glaucoma and its treatment. In
addition to knowledge gaps, patients have numerous concrete and psychological barriers to
managing their glaucoma. In addition, eye drop instillation is rarely taught, and many
patients cannot properly instill their medications.
Uniform, scripted approaches to improve adherence do not work. However, complex,
individualized counseling interventions, especially those based in motivational interviewing
(MI), have improved adherence and health outcomes in many chronic diseases. MI is a style of
counseling that engages patients by discussing priorities and obstacles to facilitate
intrinsic motivation to change health behavior. Few complex interventions based on these
successful principles have been rigorously tested and none implemented into glaucoma care.
The eyeGuide is a web-based personally tailored behavior change program based on MI
principles, a systematic review of the glaucoma adherence literature, and data from focus
groups, surveys and iterative beta-testing with glaucoma patients. It provides individually
tailored disease information and support to facilitate MI-based conversations between
patients and paraprofessional staff to improve medication adherence. Such technology-based
electronic health (eHealth) innovations have great potential to extend the reach of
physicians by enabling team-based care.
In this pilot study, the study will test the impact of two personalized eHealth technologies
on medication adherence among non-adherent glaucoma patients in a pre-post design: 1) real
time automated adherence reminders; and 2) the eyeGuide counseling program. The study will
explore the effects of these interventions on secondary outcomes including psychosocial
mediators of adherence (e.g. motivation, self-efficacy, satisfaction), intraocular pressure
(IOP), and IOP fluctuation.
Inclusion Criteria:
- Diagnosis of glaucoma, glaucoma suspect or ocular hypertension
- Taking ≥ 1 glaucoma medication
- Age ≥ 40 years
- Non-adherent to glaucoma medications by both self-report and three months of
electronic medication monitoring (adherence ≤ 80%)
Exclusion Criteria:
- Cognitive impairment
- Severe mental illness
- Do not administer own glaucoma medications
- Do not speak English
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