How Medication Adherence Affects Disease Management in Veterans with Glaucoma: Lessons Learned from a Clinical Trial.
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2023-01
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Abstract
Introduction
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.Type
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Publication Info
Buehne, Kristen L, Jullia A Rosdahl, Aaron M Hein, Sandra Woolson, Maren Olsen, Miriam Kirshner, Malina Sexton, Hayden B Bosworth, et al. (2023). How Medication Adherence Affects Disease Management in Veterans with Glaucoma: Lessons Learned from a Clinical Trial. Ophthalmic research, 66(1). pp. 489–495. 10.1159/000528857 Retrieved from https://hdl.handle.net/10161/29369.
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Scholars@Duke
Jullia Ann Rosdahl
I am a glaucoma specialist at the Duke Eye Center.
My passions are teaching, caring for patients and doctors, and saving retinal ganglion cells.
My research interests include patient education and adherence, medical and surgical education, OCT imaging for glaucoma, and physician wellness.
Maren Karine Olsen
Health services research, longitudinal data methods, missing data methods
Hayden Barry Bosworth
Dr. Bosworth is a health services researcher and Deputy Director of the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham VA Medical Center. He is also Vice Chair of Education and Professor of Population Health Sciences. He is also a Professor of Medicine, Psychiatry, and Nursing at Duke University Medical Center and Adjunct Professor in Health Policy and Administration at the School of Public Health at the University of North Carolina at Chapel Hill. His research interests comprise three overarching areas of research: 1) clinical research that provides knowledge for improving patients’ treatment adherence and self-management in chronic care; 2) translation research to improve access to quality of care; and 3) eliminate health care disparities.
Dr. Bosworth is the recipient of an American Heart Association established investigator award, the 2013 VA Undersecretary Award for Outstanding Achievement in Health Services Research (The annual award is the highest honor for VA health services researchers), and a VA Senior Career Scientist Award. In terms of self-management, Dr. Bosworth has expertise developing interventions to improve health behaviors related to hypertension, coronary artery disease, and depression, and has been developing and implementing tailored patient interventions to reduce the burden of other chronic diseases. These trials focus on motivating individuals to initiate health behaviors and sustaining them long term and use members of the healthcare team, particularly pharmacists and nurses. He has been the Principal Investigator of over 30 trials resulting in over 400 peer reviewed publications and four books. This work has been or is being implemented in multiple arenas including Medicaid of North Carolina, private payers, The United Kingdom National Health System Direct, Kaiser Health care system, and the Veterans Affairs.
Areas of Expertise: Health Behavior, Health Services Research, Implementation Science, Health Measurement, and Health Policy
Kelly Walton Muir
Kelly W. Muir, MD, specializes in the medical and surgical management of glaucoma, cataracts and general eye disease. Her research focuses on optimizing the quality of care that glaucoma patients receive by improving patient education materials, studying patient and physician communication, and developing a novel eye drop bottle that makes it easier for patients to administer their glaucoma drops. Her research has been funded by the American Glaucoma Society, the National Eye Institute, and the Veterans Health Administration. Dr. Muir also teaches medical students, residents, and fellows about glaucoma and other ophthalmologic conditions. Dr. Muir is fellowship-trained, board-certified and a member of the American Academy of Ophthalmology and American Glaucoma Society.
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