Support, Educate, Empower: The SEE Personalized Glaucoma Coaching Trial

项目摘要 尽管有有效的治疗方法，但青光眼导致的不可逆性失明的人数比 世界范围内的任何其他疾病，特别是在社会和经济上处于不利地位的群体。80%的 患者不坚持他们的青光眼处方药。非裔美国人和低收入人群 社会经济地位更有可能经历服药依从性差和与视力相关的不良反应 结果。因为更好的依从性与减少青光眼造成的视力损失有关，所以有 迫切需要更好地支持青光眼患者多样化的自我管理需求。我们的长期合作 目标是通过以下方式大幅提高不同背景患者的青光眼用药依从性 更有效地让他们参与青光眼自我管理行为。我们的科学前提是基于 之前由国家眼科研究所资助的严格工作表明需要改进自我管理 为青光眼患者提供支持。循证沟通、教育和外展战略，如 作为量身定制的教育，基于动机访谈(MI)的咨询和提醒系统可以改善 不同患者的依从性和结果。我们的中心假设是青光眼患者 参加支持、教育和授权(参见)计划的坚持将改善他们的药物治疗 坚持不懈。在SEE计划中，参与者接受1)由eHealth生成的个人定制教育 由接受过培训的健康教育者提供的面对面应用程序与基于MI的咨询相结合 青光眼教练和2)根据参与者喜好量身定做的提醒，包括音频或视觉警报和/或 当错过一剂药物时，会发短信或打电话。我们的总体目标是测试SEE计划是否， 与标准护理相比，通过在230名患者中进行的随机临床试验提高了服药依从性 入选时服药依从性差的青光眼患者。SEE计划的基本组成部分 它是否包括非医生的医疗保健提供者--健康教育者--来提供教育， 咨询，以及青光眼患者依从性差所需的支持。影响：在完成 试验中，我们将严格评估一个高度可扩展和可持续的干预措施，因为它 电子健康技术的应用和非医生提供者的使用。这项研究的证据将 告知有效的行为改变战略和方法，以解决#年的种族和社会经济差异 青光眼的结局。最终，我们的发现将为临床实践指南提供信息并通过促进 改善服药依从性和视觉效果的循证模型。

PROJECT ABSTRACT Despite the availability of effective treatments, glaucoma causes more people to become irreversibly blind than any other disease worldwide, especially among socially and economically disadvantaged groups. 80% of patients do not adhere to their prescribed glaucoma medications. African Americans and people with lower socio-economic status are more likely to experience poor medication adherence and adverse vision-related outcomes. Because improved adherence is associated with decreased vision loss from glaucoma, there is a critical need to better support the diverse self-management needs of people with glaucoma. Our long-term goal is to substantially increase glaucoma medication adherence among patients from diverse backgrounds by more effectively engaging them in glaucoma self-management behaviors. Our scientific premise is based on prior rigorous National Eye Institute-funded work demonstrating the need for improved self-management support for patients with glaucoma. Evidence-based communication, education, and outreach strategies, such as tailored education, motivational-interviewing (MI) based counseling and reminder systems, can improve adherence and outcomes for diverse patients. Our central hypothesis is that glaucoma patients with poor adherence who participate in the Support, Educate and Empower (SEE) Program will improve their medication adherence. In the SEE Program, participants receive 1) Personally tailored education generated by an eHealth application delivered in-person combined with MI-based counseling from a health educator trained as a glaucoma coach and 2) reminders tailored to participant preference including audible or visual alerts and/or text or phone calls when a dose is missed. Our overall objective is to test whether the SEE Program, compared to standard care, improves medication adherence through a randomized clinical trial among 230 glaucoma patients with poor medication adherence at enrollment. An essential component of the SEE Program is its inclusion of non-physician health care providers—health educators— to provide the education, counseling, and support that glaucoma patients with poor adherence require. Impact: Upon completion of the trial, we will have rigorously evaluated an intervention that is highly scalable and sustainable due to its application of eHealth technologies and use of non-physician providers. The evidence from this study will inform effective behavior-change strategies and approaches to address racial and socioeconomic disparities in glaucoma outcomes. Ultimately, our findings will inform and shape clinical practice guidelines by promoting evidence-based models that improve medication adherence and visual outcomes.