Communication About Glaucoma and Patient Outcomes

描述(申请人提供)：在美国，9%到12%的失明归因于青光眼。青光眼患者没有症状增加了这些患者不遵守方案的风险。大约50%开始服用青光眼药物的人在6个月内停止服药。关于青光眼及其治疗的提供者和患者之间的沟通可能是影响最初治疗依从性和持久性的关键因素。人们对青光眼提供者与患者之间的交流知之甚少。该项目的主要目的是检查患者最初开始青光眼药物治疗时发生的提供者与患者之间的沟通如何影响开始滴眼后8个月期间的服药依从性、用药持久性和眼压(IOP)。我们将研究的沟通的关键方面包括提供者在多大程度上：(A)对患者对青光眼及其治疗的看法进行个性化评估，(B)与患者合作制定目标，以及(C)提高患者的自我管理技能。我们这项研究的理论框架基于社会认知理论，因为在这三个领域中的每一个领域，更好的提供者沟通都可以潜在地提高患者的自我效能、坚持意愿和结果预期，这可能会影响我们将衡量的患者结果(用药依从性、持久性和眼压)。将在六家眼科诊所招募30名眼科医生和他们的眼科技术人员，以及420名说英语的新青光眼或青光眼疑似患者。我们会把看病的过程录下来。在医疗访问被录像后，研究助理将立即对每一名参与的患者进行访谈，录像他们的眼药水技术，并测量患者的眼压。患者的下一次就诊(通常发生在4至6周后)也将被录像，随后将对患者进行面谈。患者将在第二次视频访问后大约6个月进行跟踪和访谈，因此患者总共将被跟踪8个月。多元线性和Logistic回归，以医生为分层变量，将检验眼科医生和眼科技术人员的沟通与药物依从性和持久性、眼压、自我效能、结果预期、坚持意图和眼药水技术之间的关系。这项研究的结果可以用来教育提供者和患者如何在青光眼就诊期间优化沟通，以确保改善患者结果。如果我们发现就诊期间提供者-患者沟通的某些方面与用药依从性、持久性和眼压有关，那么我们可以设计干预研究，以测试在青光眼就诊期间改善提供者和患者之间沟通的策略，这些策略很容易应用于实践。公共卫生相关性：关于青光眼及其治疗的项目叙事提供者-患者沟通可能是影响最初治疗依从性和持久性的关键因素。人们对提供者与患者之间的沟通知之甚少。该项目的主要目的是研究在患者最初开始接受青光眼药物治疗时，提供者与患者之间的沟通如何影响开始滴眼后8个月期间的服药依从性、用药持久性和眼压。

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.