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

项目摘要 尽管有有效的治疗方法，青光眼导致更多的人成为不可逆的失明， 世界范围内的任何其他疾病，特别是在社会和经济弱势群体中。80%的 患者不坚持他们的处方青光眼药物。非裔美国人和低收入人群 社会经济地位更有可能经历不良的药物依从性和不良视力相关 结果。因为改善的依从性与青光眼引起的视力丧失减少有关， 迫切需要更好地支持青光眼患者的各种自我管理需求。我们的长期 我们的目标是通过以下措施， 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 之前严格的国家眼科研究所资助的工作表明，需要改善自我管理 青光眼的治疗方法循证交流、教育和外联战略， 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局。我们的中心假设是，青光眼患者， 参与支持、教育和赋权（SEE）计划的患者将改善他们的药物治疗 坚持。在SEE计划中，参与者将获得1）由电子健康生成的个性化教育 由一名受过培训的健康教育工作者亲自提供申请，并结合基于MI的咨询， 青光眼教练和2）针对参与者偏好定制的提醒，包括听觉或视觉警报和/或 短信或电话通知。我们的总体目标是测试SEE计划， 与标准治疗相比，通过在230名患者中进行的随机临床试验， 入组时药物依从性差的青光眼患者。SEE计划的重要组成部分 是它包含了非医生的健康护理提供者--健康教育者--来提供教育， 咨询和支持，青光眼患者的依从性差需要。影响：完成后， 试验，我们将严格评估一种干预措施，这种干预措施具有高度可扩展性和可持续性，因为它 电子保健技术的应用和非医生提供者的使用。这项研究的证据将 为有效改变行为战略和方法提供信息，以解决 青光眼结果。最终，我们的研究结果将通过促进和塑造临床实践指南， 改善药物依从性和视力结果的循证模型。

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.