Boland Michael V, Chang Dolly S, Frazier Travis, Plyler Ryan, Jefferys Joan L, Friedman David S
Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland2Division of Health Sciences Informatics, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland3Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland.
JAMA Ophthalmol. 2014 Jul;132(7):845-50. doi: 10.1001/jamaophthalmol.2014.857.
Topical glaucoma medications lower intraocular pressure and alter the course of the disease. Because adherence with glaucoma medications is a known problem, interventions are needed to help those patients who do not take their medications as prescribed.
To assess the ability of an automated telecommunication-based intervention to improve adherence with glaucoma medications.
DESIGN, SETTING, AND PARTICIPANTS: We performed a prospective cohort study of medication adherence, followed by a randomized intervention for those found to be nonadherent, of individuals recruited from a university-based glaucoma subspecialty clinic. A total of 491 participants were enrolled in the initial assessment of adherence. Of those, 70 were nonadherent with their medications after 3 months of electronic monitoring and randomized to intervention and control groups.
A personal health record was used to store the list of patient medications and reminder preferences. On the basis of those data, participants randomized to the intervention received daily messages, either text or voice, reminding them to take their medication. Participants randomized to the control group received usual care.
Difference in adherence before and after initiation of the intervention.
Using an intent-to-treat analysis, we found that the median adherence rate in the 38 participants randomized to the intervention increased from 53% to 64% (P < .05). There was no statistical change in 32 participants in the control group. To assess the real efficacy of the intervention, the same comparison was performed for the participants who successfully completed the study after randomization. Analyzed this way, the adherence rate in the 20 participants in the intervention group increased from 54% to 73% (P < .05), whereas there was again no statistical change in the 19 participants in the control group. Eighty-four percent of the participants who received reminders agreed they were helpful and would continue using them outside the study.
Automated telecommunication-based reminders linked to data in a personal health record improved adherence with once-daily glaucoma medications. This is an effective method to improve adherence that could realistically be implemented in ophthalmology practices with a minimum amount of effort on the part of the practice or the patient.
局部青光眼药物可降低眼压并改变疾病进程。由于青光眼药物治疗的依从性是一个已知问题，因此需要采取干预措施来帮助那些未按医嘱服药的患者。
评估基于自动电信的干预措施改善青光眼药物治疗依从性的能力。
设计、设置和参与者：我们对药物治疗依从性进行了一项前瞻性队列研究，随后对从大学青光眼专科诊所招募的非依从性个体进行了随机干预。共有491名参与者参加了依从性的初始评估。其中，70人在电子监测3个月后未按医嘱服药，并被随机分为干预组和对照组。
使用个人健康记录存储患者用药清单和提醒偏好。根据这些数据，随机分配到干预组的参与者每天收到短信或语音消息，提醒他们服药。随机分配到对照组的参与者接受常规护理。
干预开始前后依从性的差异。
采用意向性分析，我们发现随机分配到干预组的38名参与者的中位依从率从53%提高到了64%（P < 0.05）。对照组的32名参与者没有统计学上的变化。为了评估干预措施的实际效果，对随机分组后成功完成研究的参与者进行了同样的比较。以这种方式分析，干预组的20名参与者的依从率从54%提高到了73%（P < 0.05），而对照组的19名参与者再次没有统计学上的变化。84%收到提醒的参与者认为提醒很有帮助，并表示会在研究之外继续使用。
与个人健康记录中的数据相关联的基于自动电信的提醒提高了每日一次青光眼药物治疗的依从性。这是一种提高依从性的有效方法，可以在眼科实践中切实可行地实施，对医疗机构或患者来说只需付出最少的努力。
