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A new study published in Seminars in Ophthalmology examines the link between certain patient personalities, lifestyles, and demographics and their predicted adherence to prescribed treatments for glaucoma, in this case prescription eye drops.1 Conducted at Kashan University in Iran, the study provides an excellent cross sectional look at what influences patient compliance.
Doctors prescribe eye drops to reduce intraocular pressure and prevent the progression of glaucoma, and self-administration of eye drops is relatively easy. However, many treatment regimens involve multiple sets of eye drops, which may need to be administered in differing proportions, which complicates self-treatment. As the study points out, the more complex the dosage requirements, the more likely the patient is to lapse in treatment adherence.
The study used a psychological questionnaire called the Morisky Medication Adherence Scale to check up on the patient participants. They discovered that, though forgetfulness and lack of skill using eyedrops were cited as dissuading people from taking their medications, doctors’ answers to patient questions as well as a general lack of awareness of glaucoma complications were also critical factors in therapy compliance.
These are factors that doctors can eliminate simply by having meaningful and informative conversations with their patients. Nurses and other healthcare personnel also have the ability to be educators for their patients, and can improve medication compliance when they step into the role. There’s more to it than conversing with every patient, though. This is just the first in a series of effective therapeutic adherence methods currently being implemented.
Other research is being done to best address the patient compliance issue, including nudging via mobile applications, phone calls, and conversations between the patient and their physician or ophthalmologist. Each of these options was mentioned by the original study as being potentially promising avenues for investigation.
1. Involved Family Members
According to the study, the social environment of the patient is the single largest determinant of their medication compliance. Adherence to therapeutic eye drop prescriptions is high in patients who have nearby supportive family members during the time that they’re supposed to take their treatment. Making sure that a patient’s family is aware of the helpful role they can play will be instrumental when trying to ensure compliance with medication.
2. Mobile App Notifications
Mobile health applications (such as NudgeCoach or MediSafe) can automatically send notifications to glaucoma patients to help with medication scheduling and symptom tracking. Though there are many disease-nonspecific applications, there are also a few devoted specifically to prompting patients to take their glaucoma eye drops at certain times of the day, like the Glaucoma app. These applications are another way to encourage glaucoma patients to be aware of and on time with their prescriptions, and healthcare providers are increasingly offering similar applications to their subscribers.
3. Reminder Phone Calls
Doctors can also encourage consistent self-treatment with reminder calls.2 In one study published in the Journal of Psychology and Health, reminder calls were found to be effective at prompting patients to take their medication.
4. Goal Setting Conversations
In lieu of reminders, some doctors have taken a note from the playbook of other chronic diseases and implemented goal setting conversations into their practice. Goal setting conversations between physicians and their glaucoma patients rely on the patient’s own self-management techniques and motivation for long-term health maintenance.3
All four of these methods focus strongly on communication and support of the patient. If patients feels supported in their day-to-day life, adhering to treatment and stopping progression will more likely result.
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1 “Attributes Associated with Adherence to Glaucoma Medical Therapy and its Effects on Glaucoma Outcomes: An Evidence-Based Review and Potential Strategies to Improve Adherence.” October 2016, http://www.tandfonline.com/doi/abs/10.1080/08820538.2016.1228406.
2 “Motivational interviewing or reminders for glaucoma medication adherence: Results of a multi-site randomized controlled trial.” October 2016, http://www.tandfonline.com/doi/full/10.1080/08870446.2016.1244537?src=recsys
3 “Applying the resources and supports in self-management framework to examine ophthamologist-patient communication and glaucoma medication adherence.” September 2015, https://academic.oup.com/her/article/30/5/693/617449/Applying-the-resources-and-supports-in-self.
Last reviewed on June 20, 2017