Individualized patient care increases adherence to glaucoma therapy

Reviewed by Ahnul Ha, MD

A team of investigators led by Ahnul Ha, MD, determined that a tailored approach to glaucoma treatment improved patient adherence to glaucoma medication.¹ Ha works in the Department of Ophthalmology at Jeju National University Hospital in Jeju-si, South Korea.

The researchers conducted a network meta-analysis¹ to compare the effectiveness of interventions to improve glaucoma medication adherence. They identified randomly assigned clinical trials that compared the effects of interventions for improved adherence with ocular hypotensive therapies in adult participants.

The primary outcome measure was the mean adherence score following the intervention. Researchers analyzed the success or failure of treatments and the amount of missed doses and uncollected prescriptions during a specific time. The analysis evaluated 11 interventions, Ha explained. Specific interventions included standard of care (which served as the control), short message service, telephone call, device reminder, motivational interview, multimedia education, physician education, provision of medical records, incentives, tailored care, and enhanced standard of care.

What works better

The investigators ultimately identified 19 randomly assigned clinical trials that included 4981 patients, Results showed that tailored care involving face-to-face needs assessment and a personalized plan was superior to the standard of care (standardized mean difference, 1.28; 95% CI, 0.08-2.48). Multifaceted interventions that included tailored care showed further improvement, such as tailored care plus multimedia education (standardized mean difference, 1.44; 95% CI, 0.20-2.67) and tailored care plus multimedia education plus device reminder (standardized mean difference, 1.61; 95% CI, 0.75-2.47), the investigators reported.

The remaining interventions were ranked in descending order as follows according to their P values (probability of being the best treatment) incentives (0.606), short message service(0.535), enhanced standard of care (0.458), multimedia education (0.430), device reminder (0.429), telephone call (0.401), provision of medical records (0.391), physician education (0.281), standard of care (0.230), and motivational interview (0.165).

“The network meta-analysis found that tailored care can improve adherence to glaucoma medication compared with the control. A multifaceted approach might yield additional improvements,” the authors concluded.

“High adherence to ocular hypotensive therapies is essential for prevention of visual impairment in patients [with] glaucoma. Understanding individual patients’ needs and providing supportive strategies could be a key factor for improved adherence,” Ha said.

Ahnul Ha, MD

E: [email protected]

Ha works in the Department of Ophthalmology at Jeju National University Hospital in Jeju-si, South Korea. She has no financial interest in this subject matter.

Reference

1. Ha A, Jang M, Shim SR, Kim CY, Chang IB, Kim YK. Interventions for glaucoma medication adherence improvement: a network meta-analysis of randomized controlled trials. Ophthalmology. 2022;129(11):1294-1304. doi:10.1016/j.ophtha.2022.06.025