May 22, 2014
By Gabriel Miller
NEW YORK - A considerable proportion of glaucoma patients don't take their medicine as prescribed, but electronic monitoring and reminders can boost adherence, according to a pair of reports on a new study.
"We now have two randomized trials -- including this one -- that have demonstrated an approximately 20% increase in adherence with glaucoma medications in a group shown to be non-adherent," Dr. Michael Boland, lead author of both papers, told Reuters Health by email.
"There are no other interventions that have shown this level of improvement in this group," said Dr. Boland from Johns Hopkins University in Baltimore, Maryland.
Both papers were published online May 15 in JAMA Ophthalmology.
The study included 491 adults treated with prostaglandin eyedrops once daily. After taking a baseline survey, 407 patients completed a three-month adherence monitoring assessment using an electronic bottle cap that measured how often then took their medication.
Of these patients, 82.8% were considered adherent based on how often they took the medication, how much they took of it, and when they took it.
Factors associated with non-adherence included younger age, African descent, a shorter history of taking the medication, lower level of educational attainment, and worse mental health and depression levels.
In addition, non-adherent patients were less likely to be able to name their glaucoma medications, less likely to agree that remembering their eyedrops is easy and more likely to strongly agree with the statement that eyedrops can cause problems.
As described in the second paper, the 70 non-adherent patients were randomized to receive daily text or voice messages reminding them to take their medication based on their personal health record, or to a control group that received usual care, for an additional three months.
In an intent-to-treat analysis, the daily reminders increased adherence from 53% to 64%. Using only the 20 patients who completed the full study period, adherence increased from 54% to 73%, the researchers report.
The authors say the technology is practical for a typical ophthalmology practice. According to Memotext LLC, the manufacturer of the messaging software and a study collaborator, the program can be implemented for approximately $20 per year per patient.
Dr. James Tsai, chair of ophthalmology and visual science at Yale Medical School, said reminder systems are "very helpful," but cautioned that they are not a panacea.
An earlier study by Dr. Tsai found that there are more than 70 "distinct situational obstacles" that can lead to non-adherence in patients with glaucoma. Doctors, he told Reuters Health by email, "need to individualize therapy and utilize reminder systems -- as well as other strategies -- to improve adherence in patients."
SOURCE: http://bit.ly/1m8F84m and http://bit.ly/1to79Yz
JAMA Ophthalmol 2014.
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