Tailored care approaches may improve glaucoma medication adherence

1. In a meta-analysis of 19 randomized controlled trials, tailored care with and without additional interventions was associated with significant improvement in glaucoma medication adherence.

2. No adherence interventions, including tailored care, automatic reminders, or patient education, were associated with a significant decrease in intraocular pressure.

Evidence Rating Level: 2 (Good)

Study Rundown: Glaucoma is a chronic disease and a common cause of blindness. Prevention of vision loss requires consistent use of medications to lower intraocular pressure (IOP), which often involve regimens of multiple eye drops. This study aimed to analyze randomized controlled trials (RCTs) on interventions to improve glaucoma medication adherence using network meta-analysis. Across 19 included RCTs, nearly 5,000 patients were randomized to receive either standard of care or interventions such as extra communications and reminders, education, and incentives. Tailored care, or interventions individualized to patients, was found to have a 81.7% probability of benefit, tailored care plus multimedia education 84.6%, and tailored care combined with both multimedia education and a device reminder 87.3%. Among seven studies reporting IOP as an outcome, no interventions showed significant IOP benefit. Although different studies included patients at low risk versus high risk for medication non-adherence, this designation was not found to significantly alter results. The analyzed RCTs were highly heterogeneous, which limits interpretation of this data. A tailored care model, which includes needs assessment for each patient and creation of a personalized counseling, may be more difficult to scale than blanket interventions. However, this analysis indicates that the extra time and individualization may improve medication adherence, which is crucial for effective glaucoma treatment.

Click to read the study in Ophthalmology

Relevant Reading: Interventions to improve medication adherence: A review

In-Depth [meta-analysis]: RCTs on adult patients with open angle glaucoma or ocular hypertension, defined as IOP above 21 mmHg, were included. Interventions were categorized into the following groups: short message service, telephone call, device reminder, motivational interview, multimedia education, physician education, provision of patient’s own medical records, incentives, tailored care, and brochures or leaflets. Study durations ranged from about one month to four years. All but two included studies had low or moderate risk of bias. The standardized mean difference for tailored care was 1.28 with a 95% confidence interval of 0.08-2.48. P-scores ranking interventions on a scale from 0 to 1 ranged from 0.914 for tailored care with multimedia education and device reminder to 0.230 for standard of care to 0.165 for motivational interviews. Probability of benefit statistics were calculated based on mean adherence scores derived from trial-designated adherence measurements. The I² statistic was 90.9%, representing high heterogeneity.

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