支持、教育、授权个性化青光眼辅导试点研究对青光眼药物治疗依从性的影响。
The Impact of the Support, Educate, Empower Personalized Glaucoma Coaching Pilot Study on Glaucoma Medication Adherence.
机构信息
Department of Ophthalmology and Visual Sciences, School of Medicine, University of Michigan, Ann Arbor, Michigan.
Department of Ophthalmology and Visual Sciences, School of Medicine, University of Michigan, Ann Arbor, Michigan.
出版信息
Ophthalmol Glaucoma. 2020 Jul-Aug;3(4):228-237. doi: 10.1016/j.ogla.2020.04.013. Epub 2020 Apr 30.
PURPOSE
To assess the efficacy of the Support, Educate, Empower (SEE) glaucoma coaching program on medication adherence among glaucoma patients with low adherence.
DESIGN
Uncontrolled intervention study with a pre-post design.
PARTICIPANTS
Glaucoma patients ≥ age 40, taking ≥1 medication, who self-reported poor adherence were recruited from the University of Michigan Kellogg Eye Center. Adherence was monitored electronically for a 3-month baseline period; participants with median adherence of ≤80% were enrolled in the SEE program.
METHODS
Participants' adherence was monitored electronically (AdhereTech, New York, NY) during the 7-month program. Adherence was calculated as the percentage of doses taken on time of those prescribed. The SEE program included (1) automated medication reminders, (2) 3 in-person counseling sessions with a glaucoma coach who had training in motivational interviewing (MI), and (3) 5 phone calls with the same coach for between-session support. The coach used a web-based tool to generate an education plan tailored to the patient's glaucoma diagnosis, test results, and ophthalmologist's recommendations (www.glaucomaeyeguide.org). The tool guided an MI-based conversation between coach and patient to identify barriers to adherence and possible solutions. Descriptive statistics were used to summarize baseline patient characteristics, and differences between those who did and did not complete the SEE program were tested with 2-sample t tests, chi-square tests, and Fisher exact tests. Adherence was compared before and after the SEE program with paired t tests.
MAIN OUTCOME MEASURE
Change in electronically monitored medication adherence.
RESULTS
A total of 48 participants were enrolled. The participants were 54% male, 46% white, and on average 64 years of age (standard deviation [SD], 10.8 years), with an average worse-eye mean deviation (MD) of -7.9 dB (SD, 8.8 dB). Those completing the SEE program (n = 39) did not differ significantly from those who dropped out (n = 9) on gender, race, age, MD, or baseline adherence. Medication adherence improved from 59.9% at baseline to 81.3% (P < 0.0001) after completing the SEE program. Ninety-five percent of participants showed an improvement in adherence (mean relative improvement, 21.4%; SD, 16.5%; range, -3.2% to 74.4%; median, 20.1%). Fifty-nine percent of participants showed adherence of >80% on completing the SEE program.
CONCLUSIONS
The SEE program participants showed clinically meaningful, statistically significant improvement in glaucoma medication adherence.
目的
评估支持、教育、授权（SEE）青光眼辅导方案对低依从性青光眼患者药物依从性的疗效。
设计
未经对照的干预研究，采用前后设计。
参与者
年龄≥40 岁、服用≥1 种药物、自述依从性差的青光眼患者，从密歇根大学凯洛格眼科中心招募。在 3 个月的基线期内通过电子方式监测依从性；中位依从率≤80%的参与者被纳入 SEE 方案。
方法
参与者的依从性在 7 个月的方案期间通过电子方式（AdhereTech，纽约，NY）进行监测。依从性计算为规定剂量按时服用的百分比。SEE 方案包括（1）自动化药物提醒，（2）3 次与接受动机访谈（MI）培训的青光眼教练进行面对面咨询，（3）5 次与同一位教练进行电话沟通，以提供会话之间的支持。教练使用基于网络的工具生成针对患者青光眼诊断、测试结果和眼科医生建议的个性化教育计划（www.glaucomaeyeguide.org）。该工具指导教练和患者进行基于 MI 的对话，以确定依从性障碍和可能的解决方案。使用描述性统计数据总结基线患者特征，并使用 2 样本 t 检验、卡方检验和 Fisher 精确检验检验完成和未完成 SEE 方案的患者之间的差异。使用配对 t 检验比较 SEE 方案前后的依从性。
主要观察指标
电子监测药物依从性的变化。
结果
共有 48 名参与者入组。参与者中 54%为男性，46%为白人，平均年龄 64 岁（标准差[SD]，10.8 岁），平均较差眼平均偏差（MD）为-7.9 dB（SD，8.8 dB）。完成 SEE 方案的患者（n=39）与退出的患者（n=9）在性别、种族、年龄、MD 或基线依从性方面无显著差异。完成 SEE 方案后，药物依从性从基线时的 59.9%提高到 81.3%（P<0.0001）。95%的参与者显示出依从性的提高（平均相对改善率，21.4%；SD，16.5%；范围，-3.2%至 74.4%；中位数，20.1%）。59%的参与者在完成 SEE 方案后表现出>80%的依从性。
结论
SEE 方案参与者的青光眼药物依从性有显著的临床意义的改善。
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