Improving Glaucoma Medication Adherence

提高青光眼药物依从性

• 批准号: 9768207
• 负责人: Kelly Muir
• 金额: --
• 依托单位: DURHAM VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-03-01 至 2021-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9768207
• 关键词: Address; Adherence; Adjuvant; African American; Age; American; Blindness; Budgets; Caregivers; Caring; Chronic; Clinical; Clinical Trials; Companions; Conscious; Devices; Disease; Dose; Drops; Education; Effectiveness of Interventions; Evidence based intervention; Eye; Eye diseases; Eyedrops; Feedback; Glaucoma; Goals; Health education; Healthcare; Intervention; Laser Surgery; Lasers; Lead; Letters; Measures; Medical; Methods; Mission; Monitor; Newly Diagnosed; Operative Surgical Procedures; Ophthalmology; Outcome; Participant; Patients; Pharmaceutical Preparations; Physiologic Intraocular Pressure; Provider; Quality of life; Quality-Adjusted Life Years; Randomized; Randomized Controlled Trials; Recommendation; Records; Regimen; Reminder Systems; Research Design; Risk; Schedule; Self Efficacy; Self Management; Self Medication; Specific qualifier value; Suggestion; Surveys; Techniques; Testing; Text; Time; Translating; Veterans; Visual; Visual Fields; Visual impairment; Work; aging population; arm; base; clinically relevant; clinically significant; common treatment; comorbidity; comparison intervention; cost; cost effective; design; experience; glaucoma surgery; high risk; improved; incremental cost-effectiveness; innovation; medication compliance; medication nonadherence; mortality; multi-component intervention; novel; peer; prevent; programs; therapy design; treatment arm

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.

对退伍军人医疗保健的预期影响：超过100万退伍军人生活在无法纠正的视觉上 严重到足以降低生活质量和独立性的损伤。我们建议测试一个 旨在改善青光眼药物依从性的干预措施，最终目标是减少青光眼- 与退伍军人有关的失明。 项目背景：青光眼是退伍军人和全世界不可逆失明的主要原因。 我们由于人口老龄化，美国青光眼患者的数量正在上升，但仍然没有治愈方法。 这种疾病唯一被证明可以降低青光眼视力丧失风险的治疗方法是 降低眼内压。降低眼内压最常见的治疗方法是 青光眼滴眼液虽然多项临床试验表明，眼内压可以降低， 每天使用青光眼滴眼液和青光眼相关的视力下降可以减少，坚持 处方的青光眼治疗方案通常很差。有内科合并症的患者患青光眼的风险较高 药物治疗不依从性，这对退伍军人的视力结果是令人担忧的，因为，平均而言， 退伍军人更有可能有更多的医疗共病比他们的非退伍军人年龄匹配 同龄人 项目目标：迫切需要一种改善青光眼的循证干预措施 以合理的成本和临床相关的结果服药依从性。的目的 应用是进行随机对照试验，以评估一种旨在改善 青光眼药物依从性的退伍军人，并最终减少青光眼相关的失明。我们将 通过以下具体目标实现这一目标。 具体目标1：评价新型干预措施对改善青光眼药物依从性的影响 通过随机对照试验。 具体目标2：评价干预措施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：评估增加的成本效益以及预算和工作流程的影响 干预与对照相比。 项目方法：我们建议随机选择200名接受药物治疗的青光眼退伍军人， 2个臂中的1个，提供80%的把握度来检测规定的 在干预后6个月内，两组之间使用的青光眼药物剂量， 电子监控器。干预是多方面的，但设计简单，以促进 在忙碌临床环境中实现。眼科技师将提供明确的教育， 青光眼，解决了退伍军人在一项经验证的青光眼调查中发现的特定依从性障碍 药物自我效能，并将指导患者滴眼液给药技术，并建议眼 如果发现功能限制，则使用跌落辅助装置。技术人员将提供个性化的青光眼 药物提醒时间表退伍军人将得到一个新的药物容器，在其中存储 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 或者如果在指定的时间范围内没有访问药物，则发送语音邮件。 总之，本提案中概述的研究有可能减少青光眼相关的失明， 退伍军人，并可能导致战略，以改善自我管理，在其他慢性眼病。