Communication About Glaucoma and Patient Outcomes

描述（由申请人提供）：在美国，所有失明的9 - 12%归因于青光眼。青光眼患者没有症状会增加这些患者不依从治疗方案的风险。大约50%开始使用青光眼药物的人在6个月内停止使用。关于青光眼及其治疗的医患沟通可能是影响初始治疗依从性和持久性的关键因素。很少有人知道青光眼患者的供应商沟通。本项目的主要目的是研究患者最初开始青光眼药物治疗时发生的医患沟通如何影响药物依从性，药物持续性和滴眼液开始后8个月内的眼内压（IOP）。我们将检查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）提高患者的程度青光眼自我管理技能。本研究的理论框架基于社会认知理论，因为在这三个领域中，更好的提供者沟通可能会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测量的患者结果（药物依从性、持久性和IOP）。将在六个眼科诊所招募30名眼科医生及其眼科技术人员和420名讲英语的新青光眼或青光眼疑似患者。我们会用录像带记录医疗访问。在医疗访视被录像后，研究助理将立即与每名参与患者进行访谈，录像他们的滴眼技术，并测量患者的IOP。病人的下一次访问（通常发生在4至6周后）也将被录像带记录，然后病人将接受采访。在第二次录像访视后约6个月，将对患者进行随访和访谈，因此患者将总共随访8个月。以医生作为分层变量的多元线性和逻辑回归将研究眼科医生和眼科技师的沟通如何与药物依从性和持久性、IOP、自我效能、结局预期、依从意图和滴眼技术相关。这项研究的结果可用于教育提供者和患者如何在青光眼就诊期间优化沟通，以确保改善患者的预后。如果我们发现医疗访视期间提供者与患者沟通的某些方面与药物依从性和持续性以及IOP有关，那么我们可以设计干预研究来测试策略，以改善青光眼访视期间提供者与患者之间的沟通，这些策略可以很容易地应用于实践。公共卫生相关性：关于青光眼及其治疗的医患沟通可能是影响初始治疗依从性和持久性的关键因素。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青光眼药物治疗时发生的医患沟通如何影响药物依从性，药物持续性和滴眼液开始后8个月内的眼内压。

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.