Communication About Glaucoma and Patient Outcomes

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DESCRIPTION (provided by applicant): Between 9 and 12% of all blindness in the United States are attributed to glaucoma. The absence of symptoms in glaucoma patients increases the risk of regimen non-adherence among these patients. Approximately 50% of individuals who start on glaucoma medications discontinue them within 6 months. Provider-patient communication about glaucoma and its treatment can be a critical factor that impacts initial treatment adherence and persistence. Little is known about provider-glaucoma patient communication. The primary aim of this project is to examine how the provider-patient communication that occurs when patients are initially started on glaucoma medication treatment impacts medication adherence, medication persistence, and intraocular pressure (IOP) during the 8 month period after the drops are started. The key aspects of communication that we will examine include the extent to which providers: (a) do an individualized assessment of patients' views of glaucoma and its treatment, (b) engage in collaborative goal setting with patients, and (c) enhance patient glaucoma self management skills. Our theoretical framework for the study is based on Social Cognitive Theory because better provider communication in each of these three areas can potentially improve patient self-efficacy, intention to adhere, and outcome expectations which can impact the patient outcomes that we will measure (medication adherence, persistence, and IOP). Thirty ophthalmologists and their ophthalmic technicians and 420 English-speaking new glaucoma or glaucoma suspect patients will be recruited at six ophthalmology clinics. We will video-tape record the medical visits. Immediately after the medical visit is video-tape recorded, the research assistant will conduct an interview with each participating patient, video-tape their eye drop technique, and measure the patient's IOP. The patient's next visit (which typically occurs between four and six weeks later) will also be video-tape recorded and the patient will be interviewed afterwards. Patients will be followed and interviewed approximately 6 months after this second video-taped visit, so patients will be followed for a total of 8 months. Multiple linear and logistic regression, with physician as a stratification variable, will examine how ophthalmologist and ophthalmic technician communication is related to medication adherence and persistence, IOP, self-efficacy, outcome expectations, intention to adhere, and eye drop technique. The findings from this study can be used to educate providers and patients about how to optimize communication during glaucoma visits to assure improved patient outcomes. If we find that certain aspects of provider-patient communication during medical visits are related to medication adherence and persistence and IOP, we can then design intervention studies to test strategies to improve communication between providers and patients during glaucoma visits that could be readily adapted into practice. PUBLIC HEALTH RELEVANCE: Project Narrative Provider-patient communication about glaucoma and its treatment can be a critical factor that impacts initial treatment adherence and persistence. Little is known about provider-patient communication. The primary aim of this project is to examine how the provider-patient communication that occurs when patients are initially started on glaucoma medication treatment impacts medication adherence, medication persistence, and intraocular pressure during the 8 month period after the drops are started.