Adherence to ocular hypotensive therapy: patient health education needs and views on group education

Waterman, Heather; Brunton, Lisa; Fenerty, Cecilia; Mottershead, Jane; Richardson, Cliff; Spencer, Fiona

doi:10.2147/ppa.s37535

Cited by 17 publications

(25 citation statements)

References 26 publications

(23 reference statements)

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“…The method of sampling was purposive . To grasp many different perspectives, the authors collected data from outpatients who attended a variety of Dutch hospitals (Hospital A, B and C) each differing in several factors (Table ).…”

Section: Methodsmentioning

confidence: 99%

Why patients may not exercise their choice when referred for hospital care. An exploratory study based on interviews with patients

Victoor

Delnoij

Friele

et al. 2014

Health Expectations

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BackgroundVarious north‐western European health‐care systems encourage patients to make an active choice of health‐care provider. This study explores, qualitatively, patients' hospital selection processes and provides insight into the reasons why patients do or do not make active choices.MethodsSemi‐structured individual interviews were conducted with 142 patients in two departments of three Dutch hospitals. Interviews were recorded, transcribed and analysed in accordance with the grounded theory approach.ResultsThree levels of choice activation were identified – passive, semi‐active and active. The majority of the patients, however, visited the default hospital without having used quality information or considered alternatives. Various factors relating to patient, provider and health‐care system characteristics were identified that influenced patients' level of choice activation. On the whole, the patients interviewed could be classified into five types with regard to how they chose, or ‘ended up at’ a hospital. These types varied from patients who did not have a choice to patients who made an active choice.ConclusionsA large variation exists in the way patients choose a hospital. However, most patients tend to visit the default without being concerned about choice. Generally, they do not see any reason to choose another hospital. In addition, barriers exist to making choices. The idea of a patient who actively makes a choice originates from neoclassical microeconomic theory. However, policy makers may try in vain to bring principles originating from this theory into health care. Even so, patients do value the opportunity of attending ‘their’ own hospital.

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Section: Methodsmentioning

confidence: 99%

Why patients may not exercise their choice when referred for hospital care. An exploratory study based on interviews with patients

Victoor

Delnoij

Friele

et al. 2014

Health Expectations

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“…Having two sessions would also enable important messages to be reinforced and be in the realms of participant acceptability of duration. Supplement 1 shows the content of the program alongside the learning approach utilized, both of which were established by patients and health care professionals during the preceding action research study 20. A glaucoma-trained nurse led the educational program supported by at least one other health professional.…”

Section: Methodsmentioning

confidence: 99%

“…Action research is defined as “a participatory and cyclical process which aims to advance knowledge while executing an improvement in health care practices.”19 Our previous paper reported the identification of nine patient health education needs regarding adherence with glaucoma treatment 20. The current paper details the second stage of that project, and presents data on an exploratory study of the educational resources developed from those health education needs with the intention to use the data to develop a future randomized controlled trial (RCT) 21…”

Section: Introductionmentioning

confidence: 99%

A study to assess the feasibility of undertaking a randomized controlled trial of adherence with eye drops in glaucoma patients

Richardson¹,

Brunton²,

Olleveant³

et al. 2013

PPA

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BackgroundAdherence with therapy could influence the progression of glaucoma and ultimately affect the onset of visual impairment in some individuals. This feasibility study evaluated the measures to be used for a future randomized controlled trial assessing the effects of group-based education on adherence with eye drops.MethodsPeople diagnosed with glaucoma within the previous 12 months attending a regional ophthalmology clinic in the North West of England were recruited. A two-session education program delivered one week apart had been devised as part of a previous project. A combined adult learning and health needs approach to education was taken. Outcomes measured were knowledge of glaucoma, self-report of adherence, illness perception, beliefs about medicines, patient enablement, and general health (Short Form-12). Adherence was also measured objectively using a Medical Events Monitoring System device.ResultsTwenty-six participants consented to undertake the educational program and 19 produced analyzable data. Knowledge of glaucoma, illness perception, beliefs about medicine, and patient enablement all showed statistically significant improvements after education. Mean adherence with eye drops was maintained above 85% before and for 3 months after attendance at the educational program. Self-report exaggerated adherence by at least 10% when compared with the objective Medical Events Monitoring System data, and in fact the kappa agreement was zero.ConclusionAll questionnaires other than the Short Form-12 were considered to be valuable measures and use of a Medical Events Monitoring System device was considered to be an objective surrogate measure for adherence with eye drops. A multicenter, randomized, controlled equivalence trial of group versus individualized education using adherence as the primary outcome is the next step.

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“…We identified eleven principal reasons cited in the literature for poor glaucoma medication adherence. These included skepticism that glaucoma will cause vision loss; 12–14 skepticism that glaucoma medications are effective; 12–15 poor knowledge about glaucoma; 13, 14, 16, 17 poor self-efficacy; 14, 18 forgetfulness; 13, 14, 17, 19 cost; 13, 17, 20 difficulties with the medication schedule; 17, 19 side effects; 15, 17, 19 difficulty with eye drop administration, 13–15, 17, 19 mistrust in the physician, 21 and perceived life stress (Table 1). 22 …”

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confidence: 99%

The Most Common Barriers to Glaucoma Medication Adherence

Newman-Casey¹,

Robin²,

Blachley³

et al. 2015

Ophthalmology

355

288

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Purpose To both evaluate the frequency of eleven commonly cited barriers to optimal glaucoma medication adherence among glaucoma patients and identify barriers contributing to poor adherence. Design Prospective, cross-sectional survey. Participants 190 adults with glaucoma taking ≥1 glaucoma medication who received care in glaucoma clinics in Ann Arbor, MI and Baltimore, MD. Methods Participants completed a survey on demographic and disease characteristics, barriers to optimal glaucoma medication adherence, interest in an eye drop aid, and self-reported adherence (measured by the Morisky Adherence Scale). Descriptive statistics and logistic regression analyses were performed. Main Outcome Measures Frequency and number of barriers to adherence among both adherent and non-adherent patients. Odds ratios with 95% confidence intervals identifying barriers associated with poor adherence. Results 27% of the sample reported poor adherence. 61% of all participants cited multiple barriers and 10% cited a single barrier as impediments to optimal adherence. 29% of subjects cited no barriers, though only 13% of patients who cited no barriers were non-adherent. Among non-adherent patients, ≥31% cited each of the eleven barriers as important. Logistic regression analysis, adjusted for age, revealed that the following barriers were associated with higher odds of non-adherence: decreased self-efficacy, OR = 4.7 [95% CI 2.2–9.7, p= < 0.0001]; difficulty instilling drops, OR = 2.3 [95% CI 1.1–4.9, p= 0.03]; forgetfulness, OR = 5.6 [95% CI 2.6–12.1, p= < 0.0001]; and difficulties with the medication schedule, OR = 2.9 [1.4–6.0, p= 0.006]. For each additional barrier cited as important, there was a 10% increased odds of being non-adherent, OR = 1.1 [95% CI 1.0–1.2, p= 0.01]. Conclusion Each of the eleven barriers was important to at least 30% of surveyed patients with poor adherence, with the majority identifying multiple barriers to adherence. Low self-efficacy, forgetfulness, and difficulty with drop administration and the medication schedule were all barriers associated with poor adherence. Interventions to improve medication adherence must address each patient’s unique set of barriers.

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Adherence to ocular hypotensive therapy: patient health education needs and views on group education

Cited by 17 publications

References 26 publications

Why patients may not exercise their choice when referred for hospital care. An exploratory study based on interviews with patients

Why patients may not exercise their choice when referred for hospital care. An exploratory study based on interviews with patients

A study to assess the feasibility of undertaking a randomized controlled trial of adherence with eye drops in glaucoma patients

The Most Common Barriers to Glaucoma Medication Adherence

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