Devers Eye Institute, Portland, OR.
Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI.
J Glaucoma. 2020 Nov;29(11):1017-1024. doi: 10.1097/IJG.0000000000001616.
PRéCIS:: Univariate and multivariable models using the Glaucoma Treatment Compliance Assessment Tool (GTCAT) statements identified multiple, patient-specific factors associated with adherence that could be used to inform personalized interventions to optimize glaucoma adherence.
The purpose of this study was to determine the health behavior factors related to glaucoma adherence in patients with self-reported poor adherence.
A research coordinator used the Chang Adherence Measure and the Morisky Medication Adherence Scale to identify subjects with poor self-reported glaucoma medication adherence and enrolled them in a 3-month study to electronically monitor medication adherence. At enrollment, the coordinator administered the GTCAT. We calculated the percentage of prescribed doses taken over a 3-month period using an electronic dose monitor (AdhereTech). We used Rasch analysis, and univariate and multivariable regression to determine the GTCAT statements that predicted electronically monitored adherence.
The mean adherence was 73.8% (SD=21.04%, range: 13% to 100%). Rasch analysis showed that the GTCAT had a good overall fit and no differential bias (Anderson likelihood ratio test >0.05). Multiple GTCAT statements were associated with adherence, which represented increased knowledge, increased cues-to-action, decreased barriers, less depression, and increased self-efficacy (P<0.09 for each). The full GTCAT or a subset of statements had a high association with adherence (R range: 0.44 to 0.51, P<0.005 for all). The GTCAT identified >50% of patients who wanted more education about glaucoma; >68% who did not use reminders; and >40% who reported having difficulty using the eye drops.
The GTCAT identified multiple factors associated with adherence. Clinicians and researchers could use this tool to identify specific barriers to adherence and develop potential interventions to improve adherence.
本研究旨在确定与报告自我管理较差的患者的青光眼治疗依从性相关的健康行为因素。
研究协调员使用 Chang 依从性量表和 Morisky 药物依从性量表来识别报告自我管理较差的青光眼药物依从性差的患者，并招募他们参加为期 3 个月的研究，以电子方式监测药物依从性。在入组时，协调员进行了 GTCAT 评估。我们使用电子剂量监测仪（AdhereTech）计算了 3 个月内服用规定剂量的百分比。我们使用 Rasch 分析以及单变量和多变量回归来确定预测电子监测依从性的 GTCAT 陈述。
平均依从率为 73.8%（SD=21.04%，范围：13%至 100%）。Rasch 分析表明，GTCAT 总体拟合良好，无差异偏差（Anderson 似然比检验>0.05）。多项 GTCAT 陈述与依从性相关，代表了知识增加、线索增加、障碍减少、抑郁减轻和自我效能增加（每个 P<0.09）。完整的 GTCAT 或其陈述子集与依从性高度相关（R 范围：0.44 至 0.51，所有 P<0.005）。GTCAT 确定了>50%的患者需要更多关于青光眼的教育；>68%的患者没有使用提醒；以及>40%的患者报告在使用滴眼液时遇到困难。
GTCAT 确定了与依从性相关的多个因素。临床医生和研究人员可以使用该工具来识别具体的依从性障碍，并制定潜在的干预措施来提高依从性。
