The eyeGuide: Improving Glaucoma Self-management With a Personalized Behavior Change Program
NCT ID: NCT03159247
Last Updated: 2024-03-19
Study Results
Results pending
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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Recruitment Status
COMPLETED
Clinical Phase
NA
Total Enrollment
107 participants
Study Classification
INTERVENTIONAL
Study Start Date
2017-01-12
Study Completion Date
2020-01-10
Brief Summary
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The purpose of this research study is to test the impact of two personalized technology based programs that may help improve adherence to glaucoma medications.
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Detailed Description
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Despite evidence from randomized clinical trials that medication reduces vision loss from glaucoma, it remains the second leading cause of blindness in the United States. A critical barrier to preventing vision loss is that about one-half of glaucoma patients are essentially "untreated" because they do not adhere to their medications. Ineffective self-management behaviors and poor clinical outcomes disproportionately affect the most vulnerable members of US society. The increased burden of glaucoma due to an aging US population, together with a projected shortage of ophthalmologists, will make team-based care essential. There is a critical need to develop and test team-based, personalized behavior change interventions for glaucoma patients to improve medication adherence and the outcomes of care.
Poor adherence to effective medications is a critical barrier to better outcomes in glaucoma patients. The World Health Organization stated that "increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatments." Once diagnosed with glaucoma, at least half of patients do not adhere to their glaucoma medication regimen, return for follow-up, or persist with their medications over the longer term. Patients who are not adherent have more severe visual field loss, which leads to steep declines in health-related quality of life and increased risk of falls and motor vehicle accidents.
Adherence to glaucoma medications is rarely addressed during the clinical encounter because education and counseling programs are not part of standard glaucoma care. Focus groups have demonstrated that patients often have a poor understanding of glaucoma and its treatment. In addition to knowledge gaps, patients have numerous concrete and psychological barriers to managing their glaucoma. In addition, eye drop instillation is rarely taught, and many patients cannot properly instill their medications.
Uniform, scripted approaches to improve adherence do not work. However, complex, individualized counseling interventions, especially those based in motivational interviewing (MI), have improved adherence and health outcomes in many chronic diseases. MI is a style of counseling that engages patients by discussing priorities and obstacles to facilitate intrinsic motivation to change health behavior. Few complex interventions based on these successful principles have been rigorously tested and none implemented into glaucoma care. The eyeGuide is a web-based personally tailored behavior change program based on MI principles, a systematic review of the glaucoma adherence literature, and data from focus groups, surveys and iterative beta-testing with glaucoma patients. It provides individually tailored disease information and support to facilitate MI-based conversations between patients and paraprofessional staff to improve medication adherence. Such technology-based electronic health (eHealth) innovations have great potential to extend the reach of physicians by enabling team-based care.
In this pilot study, the study will test the impact of two personalized eHealth technologies on medication adherence among non-adherent glaucoma patients in a pre-post design: 1) real time automated adherence reminders; and 2) the eyeGuide counseling program. The study will explore the effects of these interventions on secondary outcomes including psychosocial mediators of adherence (e.g. motivation, self-efficacy, satisfaction), intraocular pressure (IOP), and IOP fluctuation.
Poor adherence to effective medications is a critical barrier to better outcomes in glaucoma patients. The World Health Organization stated that "increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatments." Once diagnosed with glaucoma, at least half of patients do not adhere to their glaucoma medication regimen, return for follow-up, or persist with their medications over the longer term. Patients who are not adherent have more severe visual field loss, which leads to steep declines in health-related quality of life and increased risk of falls and motor vehicle accidents.
Adherence to glaucoma medications is rarely addressed during the clinical encounter because education and counseling programs are not part of standard glaucoma care. Focus groups have demonstrated that patients often have a poor understanding of glaucoma and its treatment. In addition to knowledge gaps, patients have numerous concrete and psychological barriers to managing their glaucoma. In addition, eye drop instillation is rarely taught, and many patients cannot properly instill their medications.
Uniform, scripted approaches to improve adherence do not work. However, complex, individualized counseling interventions, especially those based in motivational interviewing (MI), have improved adherence and health outcomes in many chronic diseases. MI is a style of counseling that engages patients by discussing priorities and obstacles to facilitate intrinsic motivation to change health behavior. Few complex interventions based on these successful principles have been rigorously tested and none implemented into glaucoma care. The eyeGuide is a web-based personally tailored behavior change program based on MI principles, a systematic review of the glaucoma adherence literature, and data from focus groups, surveys and iterative beta-testing with glaucoma patients. It provides individually tailored disease information and support to facilitate MI-based conversations between patients and paraprofessional staff to improve medication adherence. Such technology-based electronic health (eHealth) innovations have great potential to extend the reach of physicians by enabling team-based care.
In this pilot study, the study will test the impact of two personalized eHealth technologies on medication adherence among non-adherent glaucoma patients in a pre-post design: 1) real time automated adherence reminders; and 2) the eyeGuide counseling program. The study will explore the effects of these interventions on secondary outcomes including psychosocial mediators of adherence (e.g. motivation, self-efficacy, satisfaction), intraocular pressure (IOP), and IOP fluctuation.
Conditions
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Medication Adherence
Glaucoma
Study Design
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Allocation Method
NA
Intervention Model
SINGLE_GROUP
This is a single group prospective behavioral intervention with a pre-post design. Adherence will be measured for three months at baseline, for an additional one month after an automated reminder system is initiated, for an additional six months during a personalized behavior change intervention and then for one year after the intervention.
Primary Study Purpose
HEALTH_SERVICES_RESEARCH
Blinding Strategy
NONE
Study Groups
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eyeGuide
Two personalized eHealth interventions aimed to improve glaucoma medication adherence.
Group Type
EXPERIMENTAL
eyeGuide
Intervention Type
BEHAVIORAL
The eyeGuide, a web-based tool to facilitate a personalized behavior change program for non-adherent glaucoma patients.
Interventions
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eyeGuide
The eyeGuide, a web-based tool to facilitate a personalized behavior change program for non-adherent glaucoma patients.
Intervention Type
BEHAVIORAL
Eligibility Criteria
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Inclusion Criteria
* Diagnosis of glaucoma, glaucoma suspect or ocular hypertension
* Taking ≥ 1 glaucoma medication
* Age ≥ 40 years
* Non-adherent to glaucoma medications by both self-report and three months of electronic medication monitoring (adherence ≤ 80%)
* Taking ≥ 1 glaucoma medication
* Age ≥ 40 years
* Non-adherent to glaucoma medications by both self-report and three months of electronic medication monitoring (adherence ≤ 80%)
Exclusion Criteria
* Cognitive impairment
* Severe mental illness
* Do not administer own glaucoma medications
* Do not speak English
* Severe mental illness
* Do not administer own glaucoma medications
* Do not speak English
Minimum Eligible Age
40 Years
Eligible Sex
ALL
Accepts Healthy Volunteers
No
Sponsors
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National Eye Institute (NEI)
NIH
Sponsor Role
collaborator
Research to Prevent Blindness
OTHER
Sponsor Role
collaborator
Henry Ford Health System
OTHER
Sponsor Role
collaborator
University of Michigan
OTHER
Sponsor Role
lead
Responsible Party
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Paula Anne Newman-Casey
Assistant Professor of Ophthalmology and Visual Sciences
Responsibility Role
PRINCIPAL_INVESTIGATOR
Principal Investigators
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Paula A Newman-Casey, MD, MS
Role: PRINCIPAL_INVESTIGATOR
University of Michigan
Locations
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University of Michigan
Ann Arbor, Michigan, United States
Site Status
Countries
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United States
References
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Sleath B, Blalock SJ, Stone JL, Skinner AC, Covert D, Muir K, Robin AL. Validation of a short version of the glaucoma medication self-efficacy questionnaire. Br J Ophthalmol. 2012 Feb;96(2):258-62. doi: 10.1136/bjo.2010.199851. Epub 2011 May 24.
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BACKGROUND
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BACKGROUND
Nieuwlaat R, Wilczynski N, Navarro T, Hobson N, Jeffery R, Keepanasseril A, Agoritsas T, Mistry N, Iorio A, Jack S, Sivaramalingam B, Iserman E, Mustafa RA, Jedraszewski D, Cotoi C, Haynes RB. Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2014 Nov 20;2014(11):CD000011. doi: 10.1002/14651858.CD000011.pub4.
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Newman-Casey PA, Weizer JS, Heisler M, Lee PP, Stein JD. Systematic review of educational interventions to improve glaucoma medication adherence. Semin Ophthalmol. 2013 May;28(3):191-201. doi: 10.3109/08820538.2013.771198.
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Newman-Casey PA, Shtein RM, Coleman AL, Herndon L, Lee PP. Why Patients With Glaucoma Lose Vision: The Patient Perspective. J Glaucoma. 2016 Jul;25(7):e668-75. doi: 10.1097/IJG.0000000000000320.
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BACKGROUND
Miller WR and Rollnick S. Motivational Interviewing: Helping people change, 3rd edition. 2013; Guilford Press, New York, NY.
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BACKGROUND
Schneider KJ, Hollenhorst CN, Valicevic AN, Niziol LM, Heisler M, Musch DC, Cain SM, Newman-Casey PA. Impact of the Support, Educate, Empower Personalized Glaucoma Coaching Program Pilot Study on Eye Drop Instillation Technique and Self-Efficacy. Ophthalmol Glaucoma. 2021 Jan-Feb;4(1):42-50. doi: 10.1016/j.ogla.2020.08.003. Epub 2020 Aug 8.
Reference Type
DERIVED
Sanchez FG, Mansberger SL, Newman-Casey PA. Predicting Adherence With the Glaucoma Treatment Compliance Assessment Tool. J Glaucoma. 2020 Nov;29(11):1017-1024. doi: 10.1097/IJG.0000000000001616.
Reference Type
DERIVED
Newman-Casey PA, Niziol LM, Mackenzie CK, Resnicow K, Lee PP, Musch DC, Heisler M. Personalized behavior change program for glaucoma patients with poor adherence: a pilot interventional cohort study with a pre-post design. Pilot Feasibility Stud. 2018 Jul 23;4:128. doi: 10.1186/s40814-018-0320-6. eCollection 2018.
Reference Type
DERIVED
Other Identifiers
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HUM00112614
Identifier Type: -
Identifier Source: org_study_id
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