Appendix 1
Below are 9 tables. Each consist of six columns and 2 rows. Each new table with explanations are found after a page break.
Lunnela, J, Kaarianen M, Kyngas H (2010) Adherence of Finnish people with glaucoma to treatment plans and connected factors: a cross-sectional study. International Journal of Circumpolar Health
Study Purpose& Type / Sample Characteristics / Intervention/Method / Outcome / Measures / Results / Limitations
To investigate the factors connected to adherence and to produce information for the development of effective interventions to improve adherence to treatment plans.
Cross sectional study / 513 questionnaires distributed - 249 respondents, participants with glaucoma, mean age 66years, ranging from 23 -92, predominately female (66%0
Recruited from outpatient clinic or private ophthalmologist in southern Finland.
Exclusions: long term hospitalisation.
Inclusions: min age 18, use of glaucoma medication, ability to speak Finnish
n = 249 / Duration Jul 06- 0ct 07
Questionnaires distributed with cover letter and SAE replies returned to IT service provider specialising in health care quality development. / Outcomes: information gained useful for generating future research
Measures:
Adherence Instrument (ACDI) Kyngas (2000) / Results. 242 (97%) respondents showed good adherence. Support from clinicians (p<0.001) information on consequences of treatment (p=0.003)
. / 51% response rate
Sample may not be representative of all patients with glaucoma
Recommendations
Patient support and education from health care personnel is crucial to maintain patient adherence. However, a more holistic attitude involving patients in decision making is required.
Hahn, SR (2009) Patient-centered communication to Assess and Enhance Patient Adherence to Glaucoma Medication. Ophthalmology Vol.116 No. 11.37-42
Study Purpose & Type / Sample Characteristics / Intervention/Method / Outcome / Measures / Results / LimitationsUsing an understanding of patients difficulty in revealing nonadherence and patient centered communication skills to identify and address barriers to adherence to glaucoma medication regimens. / n.a. / Article based on authors clinical experience and peer reviewed research on effective doctor-patient communication, assessment and management of non adherence. / Effective patient-doctor communication techniques enable clinicians to identify the next piece of info patient should hear, providing patient with better understanding of process. / (1) 4-step adherence ax. interview designed to detect non-adherence
(2) asking open ended questions in ask-tell-ask sequences.
(3) tailoring
interventions to patients stage of readiness for change / Secondary research. Expert opinion only.
Recommendations
Communication is more effective when based on the patient's stage of readiness to adopt adherent self management practices.
Lacey, J, Cate H, Broadway DC, (2009) Barriers to adherence with glaucoma medications: a qualitative research study. Eye23 924-932
Study Purpose& Type / Sample Characteristics / Intervention/Method / Outcome / Measures / Results / Limitations
To gain a better understanding of the obstacles to, and motivations for adherence with glaucoma medication and explore potential methods to improve adherence
Qualitative research using a phenomenological approach / Recruited from 2 NHS ophthalmic departments (Norfolk and Norwich University hospital, serving urban and rural pts and Cromer and district hospital serving rural pts.)
39 pts approached 24 recruited, 8 participants aged between 52-60yrs and 16 over 60yrs. 12 male/female
8 employed > 60yrs
23 White British/mixed British, 1 White other.
Inclusion: prev diagnosis of mod/sev. POAG, VA <6/12 , prescribed > 2 topical anti-glaucoma medications.
Exclusions: inability to speak English, desire to withhold dem. details, clinically significant medical or psychiatric condition, signif.non-glaucomatous co-morbidity i.e ARMD
intervention
n = 24 / 2 focus groups conducted, one at each hospital, Pts attended focus group at own hospital.
Following focus group, 10 one-to-one home based, semi-structured, in-depth interviews of 40-90 mins, Interviews were conducted and taped by (JL) psychologist working in isolation from clinic staff.
Written transcripts sent to all participants for 'member checking' . final data consisted of interview audio tapes and transcipts (81 463 words), researcher notes and member checking correspondence / Outcomes:
Creation of 6 themes directly reflecting participant opinion.
Measures:
'Framework' analysis and qualitative methodology successfully 'unearthed' pts opinion / Multiple obstacles to adherence identified: poor education, lack of motivation, forgetfulness, drop application. / Homogeneity of participating participants.
Recommendations
The need for individually tailored approaches with initial education about the consequences of non-adherence and longer -term feedback about drop efficacy may improve patients' motivations for adherence
Hoevenaars JGMM, Schouten JSAG, van den Borne B, Beckerw HJM, Webers CAB (2008) will improvement of knowledge lead to improvement of compliance with glaucoma medication? Acta Ophthalmologica Vol. 86 849-855
Study Purpose & Type / Sample Characteristics / Intervention / Outcome / Measures / Results / LimitationsTo identify specific items on knowledge and need for information that could be used to improve compliance with glaucoma medication.
Cross-sectional multi-centre study / 44 randomly selected ophthalmologists from Dutch Ophthalmological Society.
166 glaucoma patients.
Inclusion and exclusion documented in previous article Hoevenaars et al (2006)
n= 166 participants
n= 44 ophthalmologists / Questionnaire developed through focus group interviews, expert opinions and a pilot test. See Hoevenaars et al (2006). Included 19 items about glaucoma, 18 items about glaucoma treatment, 22 items concerning patients subjective need for information.
Rate of compliance gained through number of times medication had been used in 4 week period. Missing one dose or more regarded as non compliant. / Outcomes:
Further improving knowledge will not greatly improve compliance. / No statistically significant correlation between medication compliance and the total level of knowledge about glaucoma and its treatment (p= 0.12). / None discussed
Recommendations
Future research should focus on patient's attitude and discipline. Most successful compliance interventions are complex and include combinations of education, behavioural and affective components
Friedman DS, Hahn SR, Gelb L, Tan MS, Shah SN, Kim EE, Zimmerman TJ, Quigley HA (2008) Doctor-Patient Communication, Health-Related Beliefs and Adherence in Glaucoma. Results from the Glaucoma Adherence and Persistence Study (GAPS) Ophthalmology: Journal of The American Academy of Ophthalmology Vol. 115 No.8 1320-1327
Study Purpose& Type / Sample Characteristics / Intervention / Outcome /
Measures / Results / Limitations
To use multiple data sources to determine drivers of patient adherence to topical ocular hypotensive therapy.
Retrospective database and chart reviews in combination with prospective patient surveys / 300 participants selected from geographical diverse sample of medical claims data and patients charts between 1999 - 2005
Male - 103
Female - 197
Age > 40 years
Full details documented in Friedman et al (2007)
n = 300 / Structured interview addressing self reported adherence, experiences with medication, communication with physician and health-related beliefs associated with adherence. Telephone interviews conducted with ophthalmologists.
Full details documented in Friedman et al (2007) / Outcomes
Findings indicate doctor-patient communications/relationships and patient health beliefs contribute to adherence
Measure
Medication possession ratio (MPR) primary measure of adherence i.e. ration of days supply of medication dispensed divided by days between pharmacy fullfillments. / 8 variables associated with MPR:
1. hearing all info from doctor
2. not believing that reduced vision is a risk of not taking medication.
3. paying for medications
4. difficulty while travelling
5. not acknowledging stinging burning
6. being non white
7. receiving samples
8. not receiving a phone call visit reminder / None discussed but see Friedman et al (2007)
Recommendations
Physicians should ensure that all patients have an understanding of their disease that supports appropriate concern about future consequences.
Okeke CO, Quigley, Jampel HD, Ying G, Plyer RJ, Jiang Y, Friedman DS (2009) Interventions Improve Poor Adherence with Once Daily Glaucoma Medications in Electronically Monitored Patients. Ophthalmology: Journal of The American Academy of Ophthalmology Vol.116, No.12 2286-2293
Study Purpose& Type / Sample Characteristics / Intervention / Outcome Measures / Results / Limitations
To investigate the impact of an intervention programme to improve adherence with topical, once daily therapy for glaucoma.
RCT / Recruited from Glaucoma services Wilmer Eye Inst.
And Scheie eye Inst.
Female: 17
Male: 18
n = 35 interv.
n = 31 control / Phase 1 prospective observational cohort study of pt adherence to travoprost for 3mths
Phase 2 pts with 75% of fewer admin doses random to either intervention or control group.
multifaceted intervention administered by study staff involving:
10 min. education video stressing the importance of regular drop taking, structured discussion with study coordinator, use of a diary, reminder phone calls once per week for 1st month then every other week for 2 months, admin. of questionnaire about drop taking behaviour
Activation of audible and visible alarms on DA / Multidimensional ax carried out at baseline and 3 months
Outcomes
Change in drop use adherence determined by a electronic dosing aid (DA)
Measures
Lower IOP
DA / significantly increased adherence with glaucoma medications (p < 0.001) / Despite randomised
process intervention group were more experienced using eye drops and had low adherence rates at baseline
Patient's informed they were being monitored and provided with drugs at no cost
Recommendations
Further research is needed to determine which components of this intervention are most effective
Chen X, Chen Y, Sun X (2009) Notable role of glaucoma club on patients' knowledge of glaucoma Clinical and Experimental Ophthalmology Vol.37 pp.590-594
Study Purpose& Type / Sample Characteristics / Intervention / Outcome Measures / Results / Limitations
To assess how general glaucoma pts understand their disease compared with pts. from Shanghai Glaucoma Club / Recruited from Shanghai Glaucoma Club and general glaucoma pts.
Intervention
Male 144
Female 157
Age 58-73
Uni. 118
n=301
Control
Male 147
Female 167
Age 36-68
Uni. 83
n =314 / Questionnaire consisting of 20 questions, content: level of knowledge on glaucoma, medication compliance, lifestyle/habbits
Club offered members activities every 2 mths including lectures on glaucoma type, diet and circadian rhythms, traditional Chinese medicine, physical and mental health / Outcomes:
Significant differences in 2 groups regarding basic understanding of glaucoma / Glaucoma club offered members better medium to improve pts knowledge of disease and compliance (p < 0.01) / None discussed
but unable to generalise findings as study conducted in single city.
Recommendations
To ensure effective therapeutic outcomes an ‘open and honest’ approach to communication techniques is recommended
Budenz DL (2009) A Clinicians Guide to the Assessment and Management of Nonadherence in Glaucoma Journal of The American Academy of Ophthalmology Vol.116, No.11 pp.S43-S47
Study Purpose& Type / Sample Characteristics / Intervention/Method / Outcome Measures / Results / Limitations
To apply lessons learned in the treatment of systemic hypertension to non adherence in glaucoma treatment / n.a. / Article based on authors clinical experience and peer reviewed research / Involving empowering patients
Verbal info should be reinforced with written info
Use of nurses, other paramedical staff to reinforce education messages
Training on drop application should be ongoing
Education ineffective when used alone
Family or other social support / Simplifying medication regimes
Multifaceted and tailored interventions / Secondary research. Expert opinion only.
Recommendations
- Proactive approach from clinicians
- Use of patient centred approaches that tailor interv. to overcome specific barriers
- Combination of intervention methods
Cook PF, Bremer RW, Ayala AJ, Kahook MY (2010) Feasibility of motivational interviewing delivered by a glaucoma educator to improve medication adherence. Clinical Ophthalmology Vol. 4 pp 1091-1101
Study Purpose& Type / Sample Characteristics / Intervention / Outcome Measures / Results / Limitations
Feasibility of the introduction of a glaucoma educator / Pts from tertiary glaucoma clinics in DenverUSA
Exclusion:
Inability to admin eye drops, cognitive impairment, >80% adherence during 2mth run in phase
Surgery within 6 mths / motivational interviewing, participants assigned to the glaucoma educator received three one to one meetings and three phone calls, literature was also provided to reinforce learning. / Medication Event Monitoring System (MEMS) caps – electronic device that records the time and date a pill bottle is opened. / Treatment manual designed
8 pts assigned to glaucoma educator completed 2 of 6 planned contacts and 50% (4/8) completed 6 contacts. Pts assigned to glaucoma educator improved over time in both motivation and adherence / Small sample size
Single clinic setting
2 participating ophth. already aware of non adherence problems and committed to finding solutions
Recommendations
Use of multiple measures of adherence
Future work should compare participants'
results to a randomised control group