Personalized behavior change program for glaucoma patients with poor adherence: a pilot interventional cohort study with a pre-post design

Paula Anne Newman-Casey, Leslie M Niziol, Chamisa K Mackenzie, Kenneth Resnicow, Paul P Lee, David C Musch, Michele Heisler, Paula Anne Newman-Casey, Leslie M Niziol, Chamisa K Mackenzie, Kenneth Resnicow, Paul P Lee, David C Musch, Michele Heisler

Abstract

Background: About half of people with glaucoma do not adhere to their recommended medications. Interventions for other chronic conditions have successfully utilized reminder systems and motivational interviewing (MI)-based counseling. This study was designed to pilot a personalized intervention that leverages these strategies to assess their impact on medication adherence in glaucoma patients.

Methods: Glaucoma patients taking ≥ 1 medication will be pre-screened by telephone survey for adherence to their medication(s). Those who self-report poor adherence will be enrolled in a 3-month monitoring period to measure medication adherence using electronic medication monitors. Participants who are non-adherent (take </=80% of their medication doses) over the 3-month run in phase will be eligible for the study. We plan to enroll 57 participants who are non-adherent to their medications. Participants' adherence will then be continuously measured with electronic medication monitors, by self-report, and via pharmacy refill data over 2 years, during which two successively more resource-intensive components of an intervention aimed to improve medication adherence will be administered. The first component is a 3-month period of reminders (audio and/or visual) and text message or automated phone call if a dose of medication is not taken within a pre-specified time frame. The second component is a 6-month MI-based counseling program with a trained glaucoma counselor. This component uses the eyeGuide, a computer-based personalized behavior change program that enables para-professional staff to provide personalized education and counseling for glaucoma. The primary outcome is change in medication adherence. The secondary outcomes include changes in clinical outcomes (intraocular pressure, IOP, and IOP fluctuation) and psychosocial mediators of adherence (e.g., competence, energy for change and satisfaction). Participants will undergo semi-structured interviews at 12 months to give feedback about the counseling program in order to improve it.

Discussion: This pilot study will provide insight into ways to deliver more personalized health care to non-adherent glaucoma patients in order to better support them in managing their chronic disease.

Trial registration: Retrospectively registered with ClinicalTrials.gov (NCT03159247).

Keywords: Adherence; Counseling; Education; Glaucoma; Motivational interviewing; Tailoring.

Conflict of interest statement

This study was approved by the Institutional Review Board of the University of Michigan (Ann Arbor, MI). Informed consent will be obtained from all eligible and interested participants.Not applicable.PANC is a consultant in Blue Health Intelligence. None of the authors have any financial interest or financial conflict with the subject matter and materials discussed in the manuscript, and all authors listed their potential conflicts of interest.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Self-determination theory based theoretical model
Fig. 2
Fig. 2
eyeGuide tool screenshots
Fig. 3
Fig. 3
Pilot study timeline

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