Improving Glaucoma Medication Adherence

对退伍军人医疗保健的预期影响：超过100万退伍军人患有无法矫正的视力 严重到足以降低生活质量和独立性的损害。我们建议测试一个 旨在改善青光眼用药依从性的干预措施，最终目标是减少青光眼- 退伍军人中的相关失明。 项目背景：青光眼是导致退伍军人和青少年不可逆转失明的主要原因。 我们。由于人口老龄化，美国患有青光眼的人数正在上升，但仍没有治愈方法 这种疾病。唯一已被证实可以降低青光眼致视力丧失风险的治疗方法是 降低眼压。降低眼压最常用的治疗方法是处方 青光眼滴眼液。尽管多项临床试验表明，眼压可以通过 每天使用青光眼滴眼液可以减少青光眼相关的视力损失，坚持 开出的青光眼治疗方案往往很差。患有内科并发症的患者患青光眼的风险更高 药物不依从性，这对退伍军人的视觉结果令人担忧，因为平均而言， 退伍军人比年龄匹配的非退伍军人更有可能患有更多的医学合并症 同伴们。 项目目标：迫切需要循证干预来改善青光眼 以合理的费用和临床相关的结果坚持用药。这样做的目的是 应用程序是进行一项随机对照试验，以评估旨在改善 在退伍军人中坚持使用青光眼药物，最终减少青光眼相关的失明。我们会 通过以下具体目标来实现这一点。 具体目标1：评估一种新干预措施对改善青光眼用药依从性的影响 通过随机对照试验。 具体目标2：评估干预对青光眼强化治疗的影响 患有青光眼的退伍军人。 具体目标3：评价增加的成本效益以及预算和工作流程影响 干预组与对照组比较。 项目方法：我们建议将200名接受药物治疗的退伍军人和最多200名退伍军人随机分组 伴侣2只手臂中的1只，提供80%的力量来检测10%的处方比例差异 干预后6个月内青光眼用药剂量的测量 通过电子监视器。干预措施是多方面的，但设计简单，以促进 在繁忙的临床环境中实施。眼科技师将提供关于以下方面的明确教育 青光眼，解决老兵在青光眼有效调查中确定的坚持的具体障碍 药物自我功效，并将指导患者使用眼药水的技术，并推荐眼睛 如果确定了功能限制，则丢弃辅助设备。技术人员将提供个性化的青光眼 药物提醒日程表。退伍军人将获得一个新的药物容器，用于存储 青光眼瓶，记录药物使用的时间和日期，并通过文本提醒退伍军人 如果在指定的时间范围内没有访问药物，则可以使用语音邮件。 总之，这项提案中概述的研究有可能减少青光眼相关的失明。 并可能导致制定策略，以改善其他慢性眼病的自我管理。

Anticipated Impact on Veteran's Healthcare: Over 1 million Veterans live with uncorrectable visual impairment that is severe enough to reduce quality of life and independence. We propose to test an intervention designed to improve glaucoma medication adherence with the ultimate goal of reducing glaucoma- related blindness in Veterans. Project Background: Glaucoma is a leading cause of irreversible blindness among Veterans and across the US. The number of Americans with glaucoma is rising due to the aging population, yet there is still no cure for the disease. The only treatment that has been proven to reduce the risk of vision loss from glaucoma is lowering the intraocular pressure. The most common treatment to lower intraocular pressure is the prescription of glaucoma eye drops. Although multiple clinical trials have shown that intraocular pressure can be lowered by the daily use of glaucoma eye drops and glaucoma–related vision loss can be reduced, adherence to the prescribed glaucoma regimen is often poor. Patients with medical comorbidities are at higher risk for glaucoma medication nonadherence, which is worrisome for the visual outcomes of Veterans because, on average, Veterans are more likely to have more numerous medical co-morbidities than their non-Veteran age-matched peers. Project Objectives: There is a critical need for an evidence-based intervention that improves glaucoma medication adherence at reasonable cost and with clinically relevant outcomes. The objective of this application is to conduct a randomized, controlled trial to evaluate a novel intervention designed to improve glaucoma medication adherence in Veterans and ultimately reduce glaucoma-related blindness. We will accomplish this through the following specific aims. Specific Aim 1: Evaluate the impact of a novel intervention to improve glaucoma medication adherence through a randomized controlled trial. Specific Aim 2: Evaluate the impact of the intervention on intensification of glaucoma therapy among Veterans with glaucoma. Specific Aim 3: Evaluate the incremental cost-effectiveness and budget and workflow impacts of the intervention compared to control. Project Methods: We propose to randomize 200 Veterans with medically-treated glaucoma and up to 200 companions to 1 of 2 arms, providing 80% power to detect a 10% difference in the proportion of prescribed glaucoma medication doses taken between the 2 arms in the 6 months following the intervention as measured by electronic monitors. The intervention is multifaceted but simple in design in order to facilitate implementation in a busy clinical setting. An ophthalmic technician will provide clear education about glaucoma, addresses specific barriers to adherence identified by the Veteran in a validated survey of glaucoma medication self-efficacy, and will coach patients on eye drop administration techniques, and recommend eye drop aids if functional limitations are identified. The technician will provide an individualized glaucoma medication reminder schedule. The Veteran will be given a novel medication container in which to store the glaucoma bottle that records the time and date that the medication is accessed and alerts the Veteran via text or voicemail if the medication has not been accessed within the specified time frame. In summary, the study outlined in this proposal has the potential to reduce glaucoma-related blindness in Veterans and may lead to strategies to improve self-management in other chronic eye diseases.