Abstract
BackgroundImproving adherence to ocular hypertension (OH)/glaucoma therapy is highly likely to prevent or reduce progression of optic nerve damage. The present study used a behaviour change counselling intervention to determine whether education and support was beneficial and cost-effective in improving adherence with glaucoma therapy.MethodsA randomised controlled trial with a 13-month recruitment and 8-month follow-up period was conducted. Patients with OH/glaucoma attending a glaucoma clinic and starting treatment with travoprost were approached. Participants were randomised into two groups and adherence was measured over 8 months, using an electronic monitoring device (Travalert® dosing aid, TDA). The control group received standard clinical care, and the intervention group received a novel glaucoma education and motivational support package using behaviour change counselling. Cost-effectiveness framework analysis was used to estimate any potential cost benefit of improving adherence.ResultsTwo hundred and eight patients were recruited (102 intervention, 106 control). No significant difference in mean adherence over the monitoring period was identified with 77.2% (CI, 73.0, 81.4) for the control group and 74.8% (CI, 69.7, 79.9) for the intervention group (p = 0.47). Similarly, there was no significant difference in percentage intraocular pressure reduction; 27.6% (CI, 23.5, 31.7) for the control group and 25.3% (CI, 21.06, 29.54) for the intervention group (p = 0.45). Participants in the intervention group were more satisfied with information about glaucoma medication with a mean score of 14.47/17 (CI, 13.85, 15.0) compared with control group which was 8.51 (CI, 7.72, 9.30). The mean intervention cost per patient was GB£10.35 (<US$16) and not cost-effective.ConclusionsAdherence with travoprost was high and not further increased by the intervention. Nevertheless, the study demonstrated that provision of information, tailored to the individual, was inexpensive and able to achieve high patient satisfaction with respect to information about glaucoma medication. Measurement of adherence remains problematic since awareness of study participation may cause a change in participant behaviour.Trial registrationCurrent Controlled Trials, ISRCTN89683704.
Highlights
Improving adherence to ocular hypertension (OH)/glaucoma therapy is highly likely to prevent or reduce progression of optic nerve damage
Whilst poor glaucoma education has been cited as an explanation for non-adherence to therapy [6,7,8], interventions that purely focus on providing education have failed to achieve significant improvement in adherence [9,10,11]
The aim of the present study was to determine whether an intervention designed to both target beliefs and provide tailored education about glaucoma and its management by using a behaviour change counselling (BCC) technique [14], could be beneficial and cost-effective in improving adherence with topical therapy
Summary
Improving adherence to ocular hypertension (OH)/glaucoma therapy is highly likely to prevent or reduce progression of optic nerve damage. The present study used a behaviour change counselling intervention to determine whether education and support was beneficial and cost-effective in improving adherence with glaucoma therapy. Studies using multifaceted intervention components including education and tailoring of information, and encouraging patients to discuss strategies for incorporating the medication administration into their daily activities, have detected a significant improvement in adherence [12,13]. The aim of the present study was to determine whether an intervention designed to both target beliefs and provide tailored education about glaucoma and its management by using a behaviour change counselling (BCC) technique [14], could be beneficial and cost-effective in improving adherence with topical therapy. Previous research with the same patient population highlighted that an intervention that provided glaucoma and treatment information and motivational support was required at the point of medication initiation [7]. Paramount to the design of the intervention was the feasibility of the randomisation and delivery of the intervention during the same clinic visit as initiation of treatment and an 8 month follow-up period to establish the longevity of any intervention effect on adherence
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