Interventions improve patient adherence to therapy

San Diego—Intervention can improve patient adherence with once-daily glaucoma therapy, according to results of a randomized clinical trial reported by David S. Friedman, MD, PhD, professor of ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore.

The study included 66 patients treated with a prostaglandin analogue who had taken 75% or fewer prescribed doses as measured by a dosing aid (Travatan Dosing Aid, Alcon Laboratories) during an observation period. They were randomly assigned to a control group (31) or an intervention group (35). Patients in the control group received an eye drop prescription and routine instruction; patients in the intervention group watched a video on taking eye drops for glaucoma, interacted with the study coordinator about barriers to adherence and possible solutions, received regular reminders via the telephone, and used an alarm to remind themselves to take their drops.

At randomization and at 3 months, all patients were interviewed to determine their knowledge of glaucoma, beliefs related to health, and drop-taking behaviors. Adherence of those in the intervention group improved from 54% at baseline to 73% after intervention, whereas adherence in the control group went from 46% to 51%.

“This is a fairly modest intervention, and we improved adherence by close to 20% in those who were poorly adherent,” Dr. Friedman said. “There was virtually no change in the control group.”

The researchers need to determine which aspects of the intervention were most influential, he said.

“There have been many studies in a review of the literature that show the single interventions—a pamphlet, talk to the patient—tend to fail in chronic diseases. So that’s why we structured this…with multiple interventions,” Dr. Friedman said.

Possible solutions for patient adherence to medication include patient education, physician education, improved reminder systems, and improved monitoring of drop-taking, he said.

“If we could do it well, we probably would know and be able to target [non-adherent] people better,” Dr. Friedman said. “Patient-doctor communications are clearly a key element in this whole process.”

A new study led by Michael Boland, MD, PhD, will incorporate the use of a personal health technology platform (HealthVault, Microsoft), a system of telephone calls and text messages (MemoText, MemoText), and medication bottles embedded with microchips (MEMS [Medication Event Monitoring Systems] caps, Aardex) to determine whether such technologies can improve patient adherence to glaucoma therapy, he said.