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Higher glaucoma medication confidence exists when providers educate patients
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Researchers found higher patient confidence in adhering to glaucoma medication regimens and confidence to administer eye drops correctly when providers educated patients and assessed their views about glaucoma and its treatment.
The 8-month cohort study included 279 glaucoma patients from 15 providers across the U.S.
At baseline and 4- to 6-week follow-up visits, researchers read transcripts of patients’ medication-related questions, including questions about medication regimen, instillation procedures, side effects and adherence strategies, among others.
Researchers created a question-asking summary score by adding together the total number of medication questions the patient asked at the baseline and the follow-up visit. Patients completed a 35-item, validated, glaucoma medication self-efficacy questionnaire after the baseline and 8-month follow-up.
A total of 21 patients were lost to follow-up.
On average, providers educated patients about three glaucoma topics, and patients asked 2.5 medication-related questions. However, providers rarely assessed patient views about glaucoma and its treatment or asked patients to demonstrate their eye drop technique.
Researchers found that providers asked about patient confidence in using eye drops 24% of the time at one visit and 7% of the time at both visits. Providers sought whether the patient had questions 33% of the time at one visit and 25% of the time in both visits.
For every topic that providers educated about, patients saw a 0.35 increase in their adherence-related barriers self-efficacy score, according to researchers.
Contrary to the researchers’ hypothesis, patients who asked more questions about their glaucoma medications reported lower confidence to overcome adherence-related barriers.
Further, women and African Americans reported lower medication self-efficacy overall.
“Although education alone is unlikely to improve patient adherence, our results suggest that education may help patients feel more confident they can overcome adherence barriers, which has been associated with better adherence to glaucoma medication in previous studies,” the researchers wrote. “It is also possible that providers who spend more time educating their patients may be considered more patient-centered.” – by Abigail Sutton
Disclosure: The researchers reported no relevant financial disclosures.
Perspective
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Blair Lonsberry, OD, FAAO
Lowering IOP is the only proven glaucoma treatment, and IOP lowering is often accomplished by use of hypotensive eye drops. Many studies have demonstrated that patient adherence to medication regimens are variable and generally worse than desirable.
Carpenter and colleagues examine whether patient-provider communication increases glaucoma patients’ medication self-efficacy, which is a patient’s confidence that they can perform medically related tasks, such as instilling eye drops. Self-efficacy is associated with better medication adherence and, thus, better treatment outcomes.
The authors report that educating patients about their glaucoma and assessing their views about glaucoma can improve medication self-efficacy. Interestingly, and important to note, they found that patients who ask more medication-related questions may have less confidence in their ability to overcome barriers to adherence.
The authors conclude that one way to improve our patients’ medication adherence is to personally educate and discuss glaucoma with our patients. Of course, this takes time. As optometrists have adapted the medical model of patient care, we have delegated many tasks and spend less time with our patients. This study perhaps proves the benefit of the “old fashioned” optometrist who develops a personal relationship with his or her patients and has time to discuss these important issues.
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