Communication About Glaucoma and Patient Outcomes

描述（由申请人提供）：在美国，9%到12%的失明是由青光眼引起的。青光眼患者无症状增加了这些患者不遵守治疗方案的风险。大约50%开始服用青光眼药物的患者在6个月内停药。提供者与患者之间关于青光眼及其治疗的沟通可能是影响初始治疗依从性和持久性的关键因素。我们对青光眼患者与提供者之间的沟通知之甚少。本项目的主要目的是研究患者最初开始接受青光眼药物治疗时的医患沟通如何影响药物依从性、药物持久性和开始滴药后8个月内的眼压（IOP）。我们将考察沟通的关键方面包括提供者的程度：(a)对患者对青光眼及其治疗的看法进行个性化评估，(b)与患者合作设定目标，以及(c)提高患者青光眼自我管理技能。我们的研究理论框架是基于社会认知理论的，因为在这三个领域中，更好的提供者沟通可以潜在地提高患者的自我效能感、坚持的意愿和结果预期，这可能会影响我们将测量的患者结果（药物依从性、持久性和IOP）。将在6家眼科诊所招募30名眼科医生及其眼科技术人员和420名会说英语的青光眼或青光眼疑似患者。我们将用录像带记录出诊过程。在医疗访问被录制下来后，研究助理将立即与每位参与的患者进行访谈，记录他们滴眼液的技术，并测量患者的IOP。患者的下一次就诊（通常发生在4到6周之后）也将被录像，之后患者将接受采访。在第二次录像访视后约6个月对患者进行随访和访谈，共随访8个月。多元线性和逻辑回归，以医生作为分层变量，将检验眼科医生和眼科技术人员的沟通如何与药物依从性和持久性、IOP、自我效能、结果预期、坚持的意图和滴眼液技术相关。这项研究的结果可以用来教育提供者和患者如何优化青光眼就诊期间的沟通，以确保改善患者的预后。如果我们发现就诊期间医患沟通的某些方面与药物依从性和持久性以及IOP有关，那么我们可以设计干预研究来测试改善青光眼就诊期间医患沟通的策略，这些策略可以很容易地应用于实践。公共卫生相关性：项目叙述提供者与患者之间关于青光眼及其治疗的沟通可能是影响初始治疗依从性和持久性的关键因素。我们对医患沟通知之甚少。本项目的主要目的是研究患者最初开始接受青光眼药物治疗时的医患沟通如何影响药物依从性、药物持久性和开始滴药后8个月期间的眼压。

DESCRIPTION (provided by applicant): Between 9 and 12% of all blindness in the United States are attributed to glaucoma. The absence of symptoms in glaucoma patients increases the risk of regimen non-adherence among these patients. Approximately 50% of individuals who start on glaucoma medications discontinue them within 6 months. Provider-patient communication about glaucoma and its treatment can be a critical factor that impacts initial treatment adherence and persistence. Little is known about provider-glaucoma patient communication. The primary aim of this project is to examine how the provider-patient communication that occurs when patients are initially started on glaucoma medication treatment impacts medication adherence, medication persistence, and intraocular pressure (IOP) during the 8 month period after the drops are started. The key aspects of communication that we will examine include the extent to which providers: (a) do an individualized assessment of patients' views of glaucoma and its treatment, (b) engage in collaborative goal setting with patients, and (c) enhance patient glaucoma self management skills. Our theoretical framework for the study is based on Social Cognitive Theory because better provider communication in each of these three areas can potentially improve patient self-efficacy, intention to adhere, and outcome expectations which can impact the patient outcomes that we will measure (medication adherence, persistence, and IOP). Thirty ophthalmologists and their ophthalmic technicians and 420 English-speaking new glaucoma or glaucoma suspect patients will be recruited at six ophthalmology clinics. We will video-tape record the medical visits. Immediately after the medical visit is video-tape recorded, the research assistant will conduct an interview with each participating patient, video-tape their eye drop technique, and measure the patient's IOP. The patient's next visit (which typically occurs between four and six weeks later) will also be video-tape recorded and the patient will be interviewed afterwards. Patients will be followed and interviewed approximately 6 months after this second video-taped visit, so patients will be followed for a total of 8 months. Multiple linear and logistic regression, with physician as a stratification variable, will examine how ophthalmologist and ophthalmic technician communication is related to medication adherence and persistence, IOP, self-efficacy, outcome expectations, intention to adhere, and eye drop technique. The findings from this study can be used to educate providers and patients about how to optimize communication during glaucoma visits to assure improved patient outcomes. If we find that certain aspects of provider-patient communication during medical visits are related to medication adherence and persistence and IOP, we can then design intervention studies to test strategies to improve communication between providers and patients during glaucoma visits that could be readily adapted into practice. PUBLIC HEALTH RELEVANCE: Project Narrative Provider-patient communication about glaucoma and its treatment can be a critical factor that impacts initial treatment adherence and persistence. Little is known about provider-patient communication. The primary aim of this project is to examine how the provider-patient communication that occurs when patients are initially started on glaucoma medication treatment impacts medication adherence, medication persistence, and intraocular pressure during the 8 month period after the drops are started.