Improving African American glaucoma patient involvement in visits and outcomes

摘要 “健康人2020”的目标之一是减少与青光眼相关的视力障碍。 在美国9%到12%的失明是由于青光眼和青光眼 是导致非裔美国人不可逆转失明的主要原因。非洲裔美国人5 患青光眼的可能性是白种人的1倍， 了正确使用青光眼药物可以降低眼内压， 青光眼的进展。我们之前的研究发现， 可能由眼科医生对青光眼进行教育， 可能比白种人更容易坚持青光眼药物治疗。国家眼科研究所， 美国国立卫生研究院妇女健康办公室和青光眼研究中心 基金会都强调提高非洲裔美国人患者对 青光眼和它的治疗，以尽量减少结果的差异。先前的研究 这表明，针对非裔美国人的教育干预措施可以产生积极的影响， 对眼保健服务的利用和对年度检查重要性的信念的影响 眼科检查然而，这些研究并不针对青光眼。我们建议测试青光眼 基于社会认知理论的教育视频干预问题提示列表， 旨在改善非裔美国患者在访问期间的提问和参与， 减少差异并改善非裔美国人青光眼患者的预后。非洲 美国患者（N=380），至少接受一种青光眼药物治疗， 报告低于80%的坚持他们的药物将招募从三个 眼科实践。患者将随机接受干预或常规治疗。 在乎在访问前的等待时间，非裔美国人在干预组将观看简短的 关于积极参与访问的重要性的教育视频，他们将收到 一页的问题提示列表，他们将使用该列表检查他们想要询问的问题 医生将对患者访视进行录音，并在基线、6和 12个月患者将使用药物事件监测系统（MEMS）帽测量 他们的坚持。我们假设非洲裔美国青光眼患者 干预组与眼科医生的沟通将得到显著改善 并且这种改善的沟通将改善（a）青光眼药物治疗自我效能，（B） 依从性和（c）与常规护理相比的眼内压。

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.