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. 2023 Jan-Feb;6(1):23-28.
doi: 10.1016/j.ogla.2022.08.001. Epub 2022 Aug 8.

Glaucoma Medication Adherence 1 Year after the Support, Educate, Empower Personalized Glaucoma Coaching Program

Olivia J Killeen  1 , Leslie M Niziol  1 , Juno Cho  1 , Michele Heisler  2 , Ken Resnicow  3 , Deborah Darnley-Fisch  4 , David C Musch  5 , Paul P Lee  1 , Paula Anne Newman-Casey  6
Affiliations

Glaucoma Medication Adherence 1 Year after the Support, Educate, Empower Personalized Glaucoma Coaching Program

Olivia J Killeen et al. Ophthalmol Glaucoma. 2023 Jan-Feb.

Abstract

Purpose: To assess the efficacy of the Support, Educate, Empower (SEE) glaucoma coaching program on medication adherence among poorly adherent patients with glaucoma for 12 months after cessation of the intervention.

Design: Uncontrolled intervention study with a pre-post design.

Participants: The SEE cohort was recruited from the University of Michigan and included patients with glaucoma aged ≥ 40 years, taking ≥ 1 medication, who self-reported poor adherence. Electronic medication monitoring of those who completed the program continued for up to 1 year after the coaching intervention.

Methods: Adherence was monitored electronically (AdhereTech) during the 7-month program and 12-month follow-up period. Adherence was the percentage of doses taken on time. Participants were censored for surgery, change in glaucoma medications, or adherence monitor disuse. The SEE program included automated medication reminders, 3 in-person motivational interviewing-based counseling sessions with a glaucoma coach, and 5 phone calls with the coach for between-session support. There was no contact between the study team and participants during the 12-month follow-up after program cessation. Baseline participant characteristics were summarized with descriptive statistics. Paired t tests and Wilcoxon signed rank tests were used to investigate significant changes in monthly adherence during follow-up.

Main outcome measures: Change in electronically monitored medication adherence over the 12 months following the conclusion of the SEE program.

Results: Of 48 participants, 39 (81%) completed the SEE program and continued electronic medication monitoring for up to 1 year after program cessation. The mean age of the participants was 64 years (standard deviation [SD], 10); of the 39 participants, 56% were male, 49% were Black, and 44% were White. The mean length of follow-up was 284 days (SD, 110; range, 41-365 days). Censoring occurred in 18 (56%) participants. The mean adherence during the follow-up period was 67% (SD, 22%). This was significantly lower than the adherence during the SEE program (mean, 81%; SD, 18%; P < 0.0001) but significantly higher than the baseline preprogram adherence (mean, 60%; SD, 18%; P = 0.0393). The largest monthly losses occurred at months 1 (mean, 7%; P = 0.0001) and 4 (mean, 6%; P = 0.0077).

Conclusions: Glaucoma medication adherence decreased significantly in the year after cessation of the SEE coaching program but remained significantly higher than baseline adherence. To maintain excellent long-term medication adherence, intermittent reinforcement sessions may be necessary.

Keywords: Glaucoma; Long-term follow-up; Medication adherence.

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Conflict of interest statement

Conflict of interest: No conflicting relationship exists for any author.

Figures

Figure 1:
Figure 1:
Scatterplot of adherence during versus after SEE counseling
Figure 2:
Figure 2:
Side by side boxplots for adherence over time
See this image and copyright information in PMC

References

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