IMPROVE COMPLIANCE

The problem of sub-optimal adherence to glaucoma medication is well-documented and provides an impetus for developing strategies to improve patient behaviour. To that end, investigators at the Glaucoma Research Unit of the Norfolk & Norwich University Hospital Trust, Norwich, UK, undertook a randomised, controlled trial to evaluate whether a novel glaucoma education and motivational support programme could increase adherence among patients being initiated on IOP-lowering treatment with a topical prostaglandin analogue.

A total of 208 patients were randomised to receive the intervention or standard clinical care, and more than 90 per cent of patients in both groups completed the eight-month study. The study showed no statistically significant differences between the intervention and control groups in mean adherence rate (74.8 per cent vs. 77.2 per cent) or proportion of patients with at least 80 per cent adherence (66.7 per cent vs. 62.5 per cent).

Despite its null results, the study still contains messages about the importance of providing counselling and support to encourage adherence, according to Heidi Cate BSc, MSc, Glaucoma Research Unit Manager, and lead author of the published paper [BMC Ophthalmology. 2014;14(1):32].

“It is difficult to say precisely why we found no benefit from our intervention. However, considering the relatively and perhaps surprisingly, high rate of adherence in the control group, it may be that the counselling received as part of the research process emphasised to all patients that good medication adherence is beneficial and necessary.

“The main message may be that patients in our study were well motivated to use their drops and strived toward good adherence. Healthcare systems need to help patients achieve this goal by providing support and information, beginning when treatment is first prescribed and continuing throughout the course of care.”

Ms Cate said that the study was unique as it focused education and exploration of potential ambivalence to medication use at the point of initial diagnosis and prescribing. This timing was chosen because information from patient interviews and focus groups identifies it as when patients formulate attitudes and intentions about their newly prescribed medicines.

Questionnaires completed during the study showed the intervention patients had higher satisfaction with information received about their medication than the controls. Ms Cate told EuroTimes that further qualitative research with the study participants suggested that the intervention patients were more engaged with the “care process” and felt empowered to ask more questions about their diagnosis and treatment. “Patients who ‘engage’ and take ownership of their care and treatment may stay adherent for the lifespan of their disease. Greater satisfaction with care also works to improve the patient-doctor relationship and may improve the belief that medication is beneficial and lead to better adherence over a lifetime of use,” she said.

Heidi Cate: heidi.cate@nnuh.nhs.uk