Browsing by Author "Rosdahl, Jullia A"
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Item Open Access Finding the best glaucoma questionnaire: a qualitative and quantitative evaluation of glaucoma knowledge assessments.(Clin Ophthalmol, 2015) Rosdahl, Jullia A; Muir, Kelly WOBJECTIVE: The goal of the study was to determine which glaucoma quiz provides the best information about patient glaucoma knowledge to clinicians in clinical practice settings. METHODS: Four glaucoma quizzes were identified from the literature and national eye education programs and were qualitatively analyzed to categorize questions by topic. Quizzes were assessed by 64 glaucoma specialists using an online survey, with descriptive statistics. Comments about the quizzes were analyzed qualitatively using themes and representative quotations. RESULTS: Quizzes covered content that was important for glaucoma diagnosis and management. The National Eye Health Education Program (NEHEP) and Prevent Blindness America quizzes covered primarily diagnosis, screening, and risk factors, and the quizzes from the literature primarily covered causes of glaucoma, vision loss, eye drops, and systemic disease. Overall, the NEHEP quiz was ranked best for clinical practice, ranked first by 38%. Ranked second overall, the Gray quiz was ranked first by 34% and last by 34%. CONCLUSION: The NEHEP quiz was rated most useful for assessing baseline general glaucoma knowledge for a busy clinical practice. The Gray quiz appears to be more useful as part of a comprehensive education program, perhaps in combination with an ophthalmic educator.Item Open Access Health coaching for glaucoma care: a pilot study using mixed methods.(Clin Ophthalmol, 2015) Vin, Anita; Schneider, Suzanne; Muir, Kelly W; Rosdahl, Jullia AINTRODUCTION: Adherence to glaucoma medications is essential for successful treatment of the disease but is complex and difficult for many of our patients. Health coaching has been used successfully in the treatment of other chronic diseases. This pilot study explores the use of health coaching for glaucoma care. METHODS: A mixed methods study design was used to assess the health coaching intervention for glaucoma patients. The health coaching intervention consisted of four to six health coaching sessions with a certified health coach via telephone. Quantitative measures included demographic and health information, adherence to glaucoma medications (using the visual analog adherence scale and medication event monitoring system), and an exit survey rating the experience. Qualitative measures included a precoaching health questionnaire, notes made by the coach during the intervention, and an exit interview with the subjects at the end of the study. RESULTS: Four glaucoma patients participated in the study; all derived benefits from the health coaching. Study subjects demonstrated increased glaucoma drop adherence in response to the coaching intervention, in both visual analog scale and medication event monitoring system. Study subjects' qualitative feedback reflected a perceived improvement in both eye and general health self-care. The subjects stated that they would recommend health coaching to friends or family members. CONCLUSION: Health coaching was helpful to the glaucoma patients in this study; it has the potential to improve glaucoma care and overall health.Item Open Access Health Literacy and Success with Glaucoma Drop Administration.(Ophthalmology. Glaucoma, 2022-01) Kang, J Minjy; Chatterjee, Ayan; Rosdahl, Jullia A; Bosworth, Hayden B; Woolson, Sandra; Olsen, Maren; Sexton, Malina; Kirshner, Miriam; Muir, Kelly WPurpose
To assess the relationship between health literacy and successful glaucoma drop administration.Design
Substudy of a single-site interventional randomized controlled trial.Participants
Veterans receiving care at the Durham Veterans Affairs Eye Clinic who had a diagnosis of open-angle glaucoma were recruited if they endorsed poor drop adherence.Methods
Participants underwent a health literacy evaluation using the Rapid Estimate of Adult Literacy in Medicine (REALM) as well as a qualitative assessment of eye drop administration technique using 3 different criteria: (1) the drop was instilled in the eye, (2) only 1 drop was dispensed, and (3) the bottle was not potentially contaminated. A multivariate logistic regression model was used to assess the association of REALM score and successful drop administration, adjusting for age, disease severity, and Veterans Administration Care Assessment Needs (CAN) score.Main outcome measures
Successful drop administration.Results
Of the 179 participants with REALM scores and observed drop administration, 78% read at a high school level (HSL) or more and 22% read at less than HSL. Of the 179 participants, 87% (n = 156) successfully instilled the drop into the eye (criterion 1). A greater proportion of participants who read at HSL or more successfully instilled the drop in the eye compared with those reading at less than HSL (90.6% vs. 75.0%; P = 0.02). Rates of success with criterion 1 were similar across different levels of visual field severity. Care Assessment Needs scores were not statistically significant between those who did and those did not have successful overall drop technique.Conclusions
Poor health literacy may be associated with decreased successful drop instillation in the eye in patients with glaucoma. Screening for and considering health literacy in developing interventions to improve glaucoma self-management may improve treatment adherence in a vulnerable population.Item Open Access How Medication Adherence Affects Disease Management in Veterans with Glaucoma: Lessons Learned from a Clinical Trial.(Ophthalmic research, 2023-01) Buehne, Kristen L; Rosdahl, Jullia A; Hein, Aaron M; Woolson, Sandra; Olsen, Maren; Kirshner, Miriam; Sexton, Malina; Bosworth, Hayden B; Muir, Kelly WIntroduction
We conducted a secondary, real-world clinical assessment of a randomized controlled trial to determine how a glaucoma medication adherence intervention impacted the clinical outcomes of participants at 12 months post-randomization. Participants included veterans at a VA eye clinic with medically treated glaucoma who reported poor adherence and their companions, if applicable.Methods
The treatment group received a glaucoma education session with drop administration instruction and virtual reminders from a "smart bottle" (AdhereTech) for their eye drops. The control group received a general eye health class and the smart bottle with the reminder function turned off. Medical chart extraction determined if participants in each group experienced visual field progression, additional glaucoma medications, or a recommendation for surgery or laser due to inadequate intraocular pressure control over the 12 months following randomization. The main outcome measure was disease progression, defined as visual field progression or escalation of glaucoma therapy, in the 12 months following randomization.Results
Thirty-six versus 32% of the intervention (n = 100) versus control (n = 100) groups, respectively, experienced disease intensification. There was no difference between the intervention and control groups in terms of intensification (intervention vs. control group odds ratio: 1.20; 95% confidence interval: [0.67, 2.15]), including when age, race, and disease severity were accounted for in the logistic regression model. Those whose study dates included time during the COVID-19 pandemic were evenly distributed between groups.Conclusions
A multifaceted intervention that improved medication adherence for glaucoma for 6 months did not affect the clinical outcomes measured at 12 months post-randomization. Twelve months may not be long enough to see the clinical effect of this intervention or more than 6 months of intervention are needed.Item Open Access Identifying risk factors for blindness from primary open-angle glaucoma by race: a case-control study.(Clinical ophthalmology (Auckland, N.Z.), 2018-01) Williams, Andrew M; Huang, Wei; Muir, Kelly W; Stinnett, Sandra S; Stone, Jordan S; Rosdahl, Jullia APurpose:To examine the factors associated with blindness from primary open-angle glaucoma (POAG) among black and white patients at our institution. Patients and methods:For this retrospective, case-control study, patients legally blind from POAG ("cases") were matched on age, race, and gender with non-blind POAG patients ("controls"). Thirty-seven black case-control pairs and 19 white case-control pairs were included in this study. Clinical variables were compared at initial presentation and over the course of follow-up. Results:Black case-control pairs and white case-control pairs had similar characteristics at presentation, including cup-to-disc ratio and number of glaucoma medications. However, over the course of follow-up, black cases underwent significantly more glaucoma surgeries than matched controls (2.4 versus 1.2, p=0.001), whereas white cases and controls had no significant difference in glaucoma operations (0.9 versus 0.6, p=0.139). Our analysis found that glaucoma surgery is associated with blindness in black patients (odds ratio [OR] 1.6, 95% CI 1.1-2.2) but not in white patients (OR 1.5, 95% CI 0.7-3.2). Conclusion:Black and white case-control pairs with POAG shared similar risk factors for blindness at presentation. However, over the follow-up period, black cases required significantly more glaucoma surgeries compared to black controls, whereas there was no significant difference in surgery between white cases and controls. There was no difference in medication changes in either case-control set.Item Open Access Improved Glaucoma Medication Adherence in a Randomized Controlled Trial.(Ophthalmology. Glaucoma, 2022-01) Muir, Kelly W; Rosdahl, Jullia A; Hein, Aaron M; Woolson, Sandra; Olsen, Maren K; Kirshner, Miriam; Sexton, Malina; Bosworth, Hayden BPurpose
To test the effectiveness of an intervention designed to improve glaucoma medication adherence.Design
Randomized, controlled trial at a Veterans Affairs (VA) eye clinic.Participants
Veterans with medically treated glaucoma who reported poor adherence and their companions if applicable.Methods
Participants, and their companions if applicable, were randomized to receive an intervention to improve medication adherence that included glaucoma education, personalized disease management suggestions, and a reminder aid, or the control arm that received education regarding general eye health.Main outcome measures
The average proportion of prescribed glaucoma medication doses taken on schedule over the 6 months after randomization according to an electronic monitor between participants in the 2 arms.Results
The mean proportion of prescribed doses taken on schedule was higher in the intervention group compared with controls (0.85 vs. 0.62, P < 0.0001). The difference in proportions between the 2 groups did not vary in regressions models adjusted for companion status, frequency of dosing, and race. The longitudinal model indicated that the intervention group had significantly higher adherence during the first month after randomization and continued to stay higher through 6 months (month by treatment interaction, P = 0.003).Conclusions
A multifaceted intervention can help improve glaucoma medication adherence.Item Open Access Patient education preferences in ophthalmic care.(Patient Prefer Adherence, 2014) Rosdahl, Jullia A; Swamy, Lakshmi; Stinnett, Sandra; Muir, Kelly WBACKGROUND: The learning preferences of ophthalmology patients were examined. METHODS: Results from a voluntary survey of ophthalmology patients were analyzed for education preferences and for correlation with race, age, and ophthalmic topic. RESULTS: To learn about eye disease, patients preferred one-on-one sessions with providers as well as printed materials and websites recommended by providers. Patients currently learning from the provider were older (average age 59 years), and patients learning from the Internet (average age 49 years) and family and friends (average age 51 years) were younger. Patients interested in cataracts, glaucoma, macular degeneration, and dry eye were older; patients interested in double vision and glasses were younger. There were racial differences regarding topic preferences, with Black patients most interested in glaucoma (46%), diabetic retinopathy (31%), and cataracts (28%) and White patients most interested in cataracts (22%), glaucoma (22%), and macular degeneration (19%). CONCLUSION: MOST OPHTHALMOLOGY PATIENTS PREFERRED PERSONALIZED EDUCATION: one-on-one with their provider or a health educator and materials (printed and electronic) recommended by their provider. Age-related topics were more popular with older patients, and diseases with racial risk factors were more popular with high risk racial groups.Item Open Access Prospective Studies of Minimally Invasive Glaucoma Surgeries: Systematic Review and Quality Assessment.(Clinical ophthalmology (Auckland, N.Z.), 2020-01-24) Rosdahl, Jullia A; Gupta, DivakarGlaucoma is a common blinding disease; while there is no cure, effective treatments include medications, laser, and incisional surgery. There is significant interest from patients and doctors to develop safer surgical options throughout the spectrum of disease, to minimize treatment burden in mild glaucoma patients and to minimize risk of complications in patients needing more aggressive treatment. Surgical procedures called Minimally or Micro-Invasive Glaucoma Surgery (MIGS) are growing in popularity. Eighty-seven prospective studies on MIGS were identified and assessed for quality. Most (74%) did not have a control group. Twelve of the highest quality were reviewed. MIGS procedures appeared to have fewer complications, and lowered intraocular pressure, and reduced medication use. Studies were limited by small sample size, narrow spectrum of glaucomatous disease, and/or conflicts of interest. There is a need for high quality, independently funded and performed, comparative studies on the MIGS to help make treatment decisions.Item Open Access Randomized controlled trial of an education-based intervention to improve medication adherence: Design considerations in the medication adherence in glaucoma to improve care study.(Clinical trials (London, England), 2021-06) Rosdahl, Jullia A; Hein, Aaron M; Bosworth, Hayden B; Woolson, Sandra; Olsen, Maren; Kirshner, Miriam; Hung, Anna; Muir, Kelly WBackground
Glaucoma treatment requires patients to follow daily, often times complex, eye drop regimens, but adherence is poor for many patients, putting them at risk for irreversible vision loss. A comprehensive approach is needed to address the challenges in the self-management of glaucoma. The purpose of this study is to improve glaucoma medication adherence in Veterans with medically treated glaucoma using an education-based intervention.Methods/design
This study is a single-site randomized controlled trial enrolling 200 Veterans and their companions, if companions are involved in their care. It has two arms: an intervention group and a control group. Participants in the intervention group receive an educational session with a non-physician interventionist and are provided with an AdhereTech smart bottle with the reminder functions activated. The control group is designed as an attention control such that they have a session on general eye health and are provided with a smart bottle but without the reminder functions activated. The primary outcome is the proportion of prescribed doses taken on schedule over 6 months following randomization according to the smart bottle. Secondary outcomes include intensification of glaucoma treatment, cost of intervention delivery, and cost-effectiveness of the intervention over 12 months.Discussion
The education-based intervention that we are testing is comprehensive in scope, to encompass a variety of barriers to adherence that glaucoma patients encounter, but personalized to address issues facing individual patients. Particular attention was given to feasibility in the real-world setting, as the high throughput of patients and lack of reimbursement for educational encounters in ophthalmology would limit implementation of a resource-intensive intervention.Item Open Access Readability of patient education materials in ophthalmology: a single-institution study and systematic review.(BMC Ophthalmol, 2016-08-03) Williams, Andrew M; Muir, Kelly W; Rosdahl, Jullia ABACKGROUND: Patient education materials should be written at a level that is understandable for patients with low health literacy. The aims of this study are (1) to review the literature on readability of ophthalmic patient education materials and (2) to evaluate and revise our institution's patient education materials about glaucoma using evidence-based guidelines on writing for patients with low health literacy. METHODS: A systematic search was conducted on the PubMed/MEDLINE database for studies that have evaluated readability level of ophthalmic patient education materials, and the reported readability scores were assessed. Additionally, we collected evidence-based guidelines for writing easy-to-read patient education materials, and these recommendations were applied to revise 12 patient education handouts on various glaucoma topics at our institution. Readability measures, including Flesch-Kincaid Grade Level (FKGL), and word count were calculated for the original and revised documents. The original and revised versions of the handouts were then scored in random order by two glaucoma specialists using the Suitability Assessment of Materials (SAM) instrument, a grading scale used to evaluate suitability of health information materials for patients. Paired t test was used to analyze changes in readability measures, word count, and SAM score between original and revised handouts. Finally, five glaucoma patients were interviewed to discuss the revised materials, and patient feedback was analyzed qualitatively. RESULTS: Our literature search included 13 studies that evaluated a total of 950 educational materials. Among the mean FKGL readability scores reported in these studies, the median was 11 (representing an eleventh-grade reading level). At our institution, handouts' readability averaged a tenth-grade reading level (FKGL = 10.0 ± 1.6), but revising the handouts improved their readability to a sixth-grade reading level (FKGL = 6.4 ± 1.2) (p < 0.001). Additionally, the mean SAM score of our institution's handouts improved from 60 ± 7 % (adequate) for the original versions to 88 ± 4 % (superior) for the revised handouts (p < 0.001). CONCLUSIONS: Our systematic review of the literature reveals that ophthalmic patient education materials are consistently written at a level that is too high for many patients to understand. Our institution's experience suggests that applying guidelines on writing easy-to-understand material can improve the readability and suitability of educational materials for patients with low health literacy.Item Open Access Stress and burnout in residents: impact of mindfulness-based resilience training.(Adv Med Educ Pract, 2015) Goldhagen, Brian E; Kingsolver, Karen; Stinnett, Sandra S; Rosdahl, Jullia ABACKGROUND AND OBJECTIVE: Stress and burnout impact resident physicians. This prospective study tests the hypothesis that a mindfulness-based resilience intervention would decrease stress and burnout in residents. METHODS: Resident physicians from the Departments of Family Medicine, Psychiatry, and Anesthesia at Duke University, Durham, NC, USA, participated in two or three 1-hour sessions of mindfulness-based resilience activities, which introduced mindful-awareness and included practical exercises for nurturing resilience. Anonymous surveys were distributed before (completed by 47 residents) and after the intervention (both completed by 30 residents); a follow-up survey was distributed 1 month later (seven residents completed all three surveys). The survey included the Depression Anxiety Stress Scale, 21-question version (DASS-21), the Oldenburg Burnout Inventory, the Mindful Attention Awareness Scale, and ten questions from the Cognitive Failures Questionnaire. RESULTS: At baseline, most residents' scores were in the normal range with respect to stress; however, female residents had higher DASS-21 scores than male residents (31.7, females vs 18.4, males; P=0.002). Most residents' burnout scores were in the abnormal range, both with respect to exhaustion (38/47 residents, subscore ≥2.25) and disengagement (37/47 residents, subscore ≥2.1). Higher perceived levels of stress correlated with the instruments. Analysis of the surveys before and after the intervention showed no significant short-term change in stress, burnout, mindful-awareness, or cognitive failure. There was a trend for females and post-medical school graduate year 1 and 2 (PGY1 and PGY2) residents to have a reduction in DASS-21 scores after intervention. There was also a trend of reduced stress and burnout in residents who perceived higher stress. CONCLUSION: Residents who are female, PGY1 and PGY2, and who perceive residency to be stressful may benefit most from a mindfulness-based resilience intervention.Item Open Access The Button Project: Using Chart Rounds for Teaching Clinical Ophthalmology with an Electronic Medical Record.(Advances in medical education and practice, 2019-01) Rosdahl, Jullia A; Zhang, Wenlan; Manjunath, VarshaObjective
Chart rounds have traditionally been used effectively for clinical teaching in ophthalmology. The introduction of the electronic health record has altered practice patterns and some evidence suggests interference with resident education. The purpose of this study was to investigate the use of chart rounds in our ophthalmology department and to see if a simple intervention, an "education button", could positively impact clinical teaching.Design
We used a cross-sectional survey, and pre- and post-intervention surveys to assess the utility of an intervention - an "education button".Setting
Department of Ophthalmology at Duke University, a tertiary care academic ophthalmology practice, in Durham, North Carolina.Participants
Ophthalmology trainees (37), including residents and clinical fellows, and clinical faculty (50) in the department were surveyed anonymously. The overall response rate for the cross-sectional survey was 83% (72/87). The overall response rate for the educational study was 53% for the first time-point and 59% for the second time-point.Results
For the cross-sectional survey, trainees found chart rounds to be useful and would like to increase their frequency. Most faculty reported doing them regularly, although not having enough time was the most common barrier (76% of the faculty). In the pre- and post-assessment of the "education button" (overall response rate 53%), the overall impression was positive with the button easy to use, but the implementation of the button did not appear to change the quality or frequency of chart rounds; nor did it appear to have an effect on covering learning objectives.Conclusion
While the "education button" could help with communication between the faculty and trainees during a busy clinic session to identify cases for discussion, it did not address the most common barrier identified by faculty members, that of not having enough time.Item Open Access Validation of a glaucoma knowledge assessment in glaucoma patients.(Clin Ophthalmol, 2016) Rao, Veena S; Peralta, Esteban A; Rosdahl, Jullia ASUMMARY: To develop metrics to identify knowledge deficits and barriers to learning in glaucoma patients, this study seeks to validate a glaucoma knowledge assessment to use in the evaluation of knowledge in glaucoma patients. PURPOSE: Glaucoma treatment adherence appears to improve when patients demonstrate a greater knowledge of the disease and its treatment. This study seeks to validate a glaucoma knowledge assessment in a glaucoma patient population to assist in patient educational assessments and interventions. PATIENTS AND METHODS: The National Eye Health Education Program's (NEHEP) glaucoma knowledge assessment has previously been suggested as a useful measure to assess glaucoma patient's knowledge. This questionnaire was administered in glaucoma patients along with a more comprehensive 49-question examination. Demographic data and health literacy were assessed. Statistical analyses were performed to assess the validity of the assessments. RESULTS: A total of 12 glaucoma patients completed the knowledge assessments. The mean ± standard deviation age of the patients was 69±14 years, and the duration of glaucoma was 14±13 years. The participants' mean score on the NEHEP assessment was 7.3±0.8 (of 10, 73% correct) vs 29.3±7.3 (of 49, 60% correct) on the comprehensive assessment. The value of coefficient α was 0.592 for NEHEP and 0.872 for the cumulative assessment. The P-value (proportion of examinees answering correctly) ranged from 0 to 1 for individual questions. Item point-biserial correlation values for each question ranged from -0.402 to 0.813. DISCUSSION: The NEHEP quiz may be a good starting point for the development of a reliable knowledge assessment tool to measure and monitor glaucoma knowledge, due to its concise nature and reasonable level of difficulty. This study suggests that questions included in the currently available questionnaires vary widely in difficulty and ability to differentiate knowledge level, which may ultimately compromise reliability and utility of existing examinations. Further examination of individual questions and teaching points included in the current assessments may help to construct increasingly reliable and useful knowledge assessments in the future.Item Open Access Within-Trial Cost-Effectiveness of an Adherence-Enhancing Educational Intervention for Glaucoma.(American journal of ophthalmology, 2022-12) Williams, Andrew M; Theophanous, Christos; Muir, Kelly W; Rosdahl, Jullia A; Woolson, Sandra; Olsen, Maren; Bosworth, Hayden B; Hung, AnnaPurpose
To assess the within-trial cost-effectiveness of a behavioral intervention to improve glaucoma medication adherence.Design
Prospective cost-effectiveness analysis of randomized, controlled trial data.Methods
The study setting was a Veterans Affairs (VA) eye clinic. The patient population comprised veterans with medically treated glaucoma and self-reported poor adherence. Participants were randomized to a personalized educational session with a reminder bottle to promote medication adherence or to a control session on general eye health. Costs were assessed from the perspective of the VA payor at 6 months using the VA Managerial Cost Accounting System. Probabilistic sensitivity analyses were conducted using bootstrapped samples. The main outcome measures were the proportion of participants attaining ≥80% adherence as measured by electronic monitor, total intervention and medical resource costs, and incremental cost-effectiveness ratios comparing intervention to control at 6 months.Results
Of 200 randomized participants, 95 of 100 assigned to the intervention and 97 of 100 assigned to the control had adherence outcomes at 6 months, and the proportion of adherent patients was higher in the intervention group compared to control (0.78 vs 0.40, P < .0001). All participants had costs at 6 months. The total cost at 6 months was $1,149,600 in the intervention group (n = 100) compared to $1,298,700 in the control group (n = 100). Thus, in a hypothetical cohort of 100 patients, the intervention was associated with cost savings (-$149,100) and resulted in 38 additional patients achieving medication adherence.Conclusions
An adherence-enhancing behavioral intervention was effective and cost saving at 6 months.