Automated Telecommunication-Based Reminders and Adherence With Once-Daily Glaucoma Medication Dosing The Automated Dosing Reminder Study
Automated Telecommunication-Based Reminders and Adherence With Once-Daily Glaucoma Medication Dosing The Automated Dosing Reminder Study
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DOI：
10.1001/jamaophthalmol.2014.857
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发表时间：
2014-07-01
影响因子：
8.1
通讯作者：
Friedman, David S.
中科院分区：
文献类型：
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作者：
Boland, Michael V.;Chang, Dolly S.;Friedman, David S.
重要的是，局部使用青光眼药物可降低眼压并改变病程。因为青光眼药物的依从性是一个已知的问题，所以需要干预措施来帮助那些没有按处方服药的患者。目的评估基于自动通信的干预措施改善青光眼药物依从性的能力。设计、设置和参与者我们对从大学青光眼专科诊所招募的个体进行了一项前瞻性队列研究，研究对象是药物依从性，然后对那些被发现不依从者进行随机干预。共有491名参与者参加了遵守情况的初步评估。在这些患者中，70人在电子监测3个月后未坚持服药，并被随机分为干预组和对照组。干预措施个人健康记录被用来存储患者的用药列表和提醒偏好。根据这些数据，随机参加干预的参与者每天都会收到短信或语音，提醒他们服用药物。结果采用意向处理分析，我们发现38名随机参加干预的参与者的中位依从率从53%增加到%(P<；0.05)。对照组32名受试者无统计学变化。为了评估干预的实际效果，在随机分组后，对成功完成研究的参与者进行了同样的比较。这样分析，干预组的20名参与者的依从率从54%增加到73%(P<；0.05)，而对照组的19名参与者的依从率又没有统计学上的变化。在收到提醒的参与者中，84%的人同意他们是有帮助的，并将在研究之外继续使用这些提醒。结论和基于关联电信的提醒与个人健康记录中的数据相关联，提高了每天一次的青光眼药物的依从性。这是一种有效的提高依从性的方法，可以在眼科实践中实际实施，而医生或患者只需付出最少的努力。
IMPORTANCE Topical glaucoma medications lower intraocular pressure and alter the course of the disease. Because adherence with glaucoma medications is a known problem, interventions are needed to help those patients who do not take their medications as prescribed.OBJECTIVE To assess the ability of an automated telecommunication-based intervention to improve adherence with glaucoma medications.DESIGN, SETTING, AND PARTICIPANTS We performed a prospective cohort study of medication adherence, followed by a randomized intervention for those found to be nonadherent, of individuals recruited from a university-based glaucoma subspecialty clinic. A total of 491 participants were enrolled in the initial assessment of adherence. Of those, 70 were nonadherent with their medications after 3 months of electronic monitoring and randomized to intervention and control groups.INTERVENTIONS A personal health record was used to store the list of patient medications and reminder preferences. On the basis of those data, participants randomized to the intervention received daily messages, either text or voice, reminding them to take their medication. Participants randomized to the control group received usual care.MAIN OUTCOMES AND MEASURES Difference in adherence before and after initiation of the intervention.RESULTS Using an intent-to-treat analysis, we found that the median adherence rate in the 38 participants randomized to the intervention increased from 53% to 64%(P < .05). There was no statistical change in 32 participants in the control group. To assess the real efficacy of the intervention, the same comparison was performed for the participants who successfully completed the study after randomization. Analyzed this way, the adherence rate in the 20 participants in the intervention group increased from 54% to 73%(P < .05), whereas there was again no statistical change in the 19 participants in the control group. Eighty-four percent of the participants who received reminders agreed they were helpful and would continue using them outside the study.CONCLUSIONS AND RELEVANCE Automated telecommunication-based reminders linked to data in a personal health record improved adherence with once-daily glaucoma medications. This is an effectivemethod to improve adherence that could realistically be implemented in ophthalmology practices with a minimum amount of effort on the part of the practice or the patient.