Improving African American glaucoma patient involvement in visits and outcomes

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ABSTRACT One of the goals of Healthy People 2020 is to reduce glaucoma-related visual impairment. Between 9% and 12% of blindness in the United States is attributed to glaucoma and glaucoma is the leading cause of irreversible blindness in African Americans. African Americans are 5 times more likely to get glaucoma than Caucasians and are 6 times more likely to go blind from it. Proper use of glaucoma medications can lower intraocular pressure and reduce the progression of glaucoma. Our prior work found that African Americans were significantly less likely to be educated about glaucoma by their ophthalmologists and they were significantly less likely to be adherent to their glaucoma medications than Caucasians. The National Eye Institute, the Office of Women's Health at the National Institutes of Health, and the Glaucoma Research Foundation all emphasize the importance of improving African American patients' understanding of both glaucoma and its treatment to minimize disparities in outcomes. Prior studies have demonstrated that educational interventions targeted to African Americans can have a positive effect on the utilization of eye care services and on the beliefs about the importance of annual eye exams. However, these studies did not target glaucoma. We propose to test a glaucoma question prompt list with educational video intervention based on Social Cognitive Theory that is designed to improve African American patient question asking and involvement during visits to reduce disparities and improve the outcomes of African Americans with glaucoma. African American patients (N=380) who are on at least one medication for glaucoma and who self- report being less than 80 percent adherent to their medications will be recruited from three ophthalmology practices. Patients will be randomized to either receive the intervention or usual care. During pre-visit wait time, African Americans in the intervention group will watch a brief educational video on the importance of being actively involved during visits and they will receive the one-page question prompt list which they will use to check which questions they want to ask the doctor. Patient visits will be audio-taped and patients will be interviewed at baseline, 6, and 12 months. Patients will use Medication Event Monitoring System (MEMS) caps to measure their adherence. We hypothesize that African American patients with glaucoma in the intervention group will have significantly improved communication with their ophthalmologists and this improved communication will improve (a) glaucoma medication self-efficacy, (b) adherence, and (c) intraocular pressure when compared to usual care.