The Impact of the Support, Educate, Empower Personalized Glaucoma Coaching Pilot Study on Glaucoma Medication Adherence

Abstract

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.

Figure 1.

Flow Chart of Participant Recruitment and Participation (CONSORT Diagram) EHR, Electronic Health Record; SEE, Support Educate Empower * One participant was also non-adherent to seizure medications and seized during the counseling session and was disqualified from the study, one had non-diagnosed cognitive issues and was unable to participate, one let us know that she did not have enough time to participate in study visits, one moved, and five were lost to follow-up.

Figure 2.

a. Distribution of medication adherence before and during the Support, Educate, Empower (SEE) Program personalized glaucoma coaching intervention for the 39 participants who completed the intervention using boxplots. Mean and 95% confidence intervals are displayed. b. Distribution of medication adherence at baseline and during the study period for the 39 subjects completing the Support, Educate, Empower (SEE) Program personalized glaucoma coaching intervention using a Spaghetti plot. A locally estimated scatterplot smoothing (LOESS) curve is represented by the black dashed line. Mean and 95% confidence intervals are displayed.