Appendix 1
Below are 9 tables. Each consist of six columns and 2 rows. Each new table with explanations are found after a
page break.
Lunnela, J, Kaarianen M, Kyngas H (2010) Adherence of Finnish people with glaucoma to treatment plans and
connected factors: a cross-sectional study. International Journal of Circumpolar Health
Study
Purpose
& Type
To
investigate
the factors
connected to
adherence
and to
produce
information
for the
development
of effective
interventions
to improve
adherence to
treatment
plans.
Sample
Characteristics
Intervention/Method
513 questionnaires
distributed - 249
respondents,
participants with
glaucoma, mean
age 66years,
ranging from 23 -92,
predominately
female (66%0
Duration Jul 06- 0ct 07 Outcomes:
information
Questionnaires
gained useful
distributed with cover
for generating
letter and SAE replies future
returned to IT service
research
provider specialising in
health care quality
Measures:
development.
Adherence
Instrument
(ACDI)
Kyngas
(2000)
Recruited from
outpatient clinic or
private
ophthalmologist in
southern Finland.
Exclusions: long
Outcome /
Measures
Results
Limitations
Results. 242
(97%)
respondents
showed good
adherence.
Support from
clinicians
(p<0.001)
information
on
consequence
s of treatment
(p=0.003)
51% response rate
.
Sample may not be
representative of all
patients with
glaucoma
Recommendations
Patient support and
education from
health care
personnel is crucial
to maintain patient
adherence.
However, a more
holistic attitude
involving patients in
Cross
sectional
study
term hospitalisation.
Inclusions: min
age 18, use of
glaucoma
medication, ability
to speak Finnish
n = 249
decision making is
required.
Hahn, SR (2009) Patient-centered communication to Assess and Enhance Patient Adherence to Glaucoma
Medication. Ophthalmology Vol.116 No. 11.37-42
Study
Purpose &
Type
Using an
understanding
of patients
difficulty in
revealing
nonadherence
and patient
centered
communication
skills to identify
and address
barriers to
adherence to
glaucoma
medication
regimens.
Sample
Intervention/Method Outcome /
Characteristics
Measures
n.a.
Article based on
authors clinical
experience and peer
reviewed research
on effective doctorpatient
communication,
assessment and
management of non
adherence.
Results
(1) 4-step
Effective
adherence ax.
patient-doctor
interview
communication designed to
techniques
detect nonenable
adherence
clinicians to
identify the
(2) asking
next piece of
open ended
info patient
questions in
should hear,
ask-tell-ask
providing
sequences.
patient with
better
(3) tailoring
understanding interventions
of process.
to patients
stage of
readiness for
change
Limitations
Secondary
research. Expert
opinion only.
Recommendations
Communication is
more effective
when based on the
patient's stage of
readiness to adopt
adherent self
management
practices.
Lacey, J, Cate H, Broadway DC, (2009) Barriers to adherence with glaucoma medications: a qualitative research
study. Eye23 924-932
Study Purpose
& Type
To gain a better
understanding of
the obstacles to,
and motivations
for adherence
with glaucoma
medication and
explore potential
methods to
improve
adherence
Sample
Characteristics
Recruited from 2
NHS ophthalmic
departments
(Norfolk and
Norwich University
hospital, serving
urban and rural pts
and Cromer and
district hospital
serving rural pts.)
Intervention/Meth
od
2 focus groups
conducted, one at
each hospital, Pts
attended focus
group at own
hospital.
Following focus
group, 10 one-toone home based,
semi-structured, indepth interviews of
39 pts approached 40-90 mins,
Qualitative
24 recruited, 8
Interviews were
research using a participants aged
conducted and
phenomenological between 52-60yrs taped by (JL)
approach
and 16 over 60yrs. psychologist
12 male/female
working in isolation
8 employed >
from clinic staff.
60yrs
23 White
Written transcripts
British/mixed
sent to all
Outcome /
Measures
Outcomes:
Creation of 6
themes
directly
reflecting
participant
opinion.
Results
Multiple
obstacles to
adherence
identified:
poor
education,
lack of
motivation,
Measures:
forgetfulness,
'Framework' drop
analysis and application.
qualitative
methodology
successfully
'unearthed'
pts opinion
Limitations
Homogeneity of
participating
participants.
Recommendations
The need for
individually tailored
approaches with
initial education
about the
consequences of
non-adherence and
longer -term
feedback about
drop efficacy may
improve patients'
motivations for
adherence
British, 1 White
other.
Inclusion: prev
diagnosis of
mod/sev. POAG,
VA <6/12 ,
prescribed > 2
topical antiglaucoma
medications.
Exclusions:
inability to speak
English, desire to
withhold dem.
details, clinically
significant medical
or psychiatric
condition,
signif.nonglaucomatous comorbidity i.e
ARMD
intervention
n = 24
participants for
'member checking'
. final data
consisted of
interview audio
tapes and
transcipts (81 463
words), researcher
notes and member
checking
correspondence
Hoevenaars JGMM, Schouten JSAG, van den Borne B, Beckerw HJM, Webers CAB (2008) will improvement of
knowledge lead to improvement of compliance with glaucoma medication? Acta Ophthalmologica Vol. 86 849855
Study
Purpose &
Type
To identify
specific items
on knowledge
and need for
information
that could be
used to
improve
compliance
with glaucoma
medication.
Sample
Characteristics
44 randomly
selected
ophthalmologists
from Dutch
Ophthalmological
Society.
166 glaucoma
patients.
Intervention
Questionnaire
developed
through focus
group interviews,
expert opinions
and a pilot test.
See Hoevenaars
et al (2006).
Included 19
Inclusion and
items about
exclusion
glaucoma, 18
documented in
items about
previous article
glaucoma
CrossHoevenaars et al treatment, 22
sectional multi- (2006)
items concerning
centre study
patients
n= 166
subjective need
participants
for information.
n= 44
Outcome /
Measures
Results
Limitations
Outcomes:
Further
improving
knowledge
will not greatly
improve
compliance.
No statistically
significant
correlation
between
medication
compliance and
the total level of
knowledge about
glaucoma and its
treatment (p=
0.12).
None discussed
Recommendations
Future research
should focus on
patient's attitude
and discipline. Most
successful
compliance
interventions are
complex and
include
combinations of
education,
behavioural and
affective
components
ophthalmologists Rate of
compliance
gained through
number of times
medication had
been used in 4
week period.
Missing one
dose or more
regarded as non
compliant.
Friedman DS, Hahn SR, Gelb L, Tan MS, Shah SN, Kim EE, Zimmerman TJ, Quigley HA (2008) Doctor-Patient
Communication, Health-Related Beliefs and Adherence in Glaucoma. Results from the Glaucoma Adherence
and Persistence Study (GAPS) Ophthalmology: Journal of The American Academy of Ophthalmology Vol. 115
No.8 1320-1327
Study
Purpose
& Type
To use
multiple data
sources to
determine
drivers of
patient
adherence to
topical ocular
hypotensive
therapy.
Retrospectiv
e database
and chart
reviews in
combination
with
prospective
Sample
Characteristics
Intervention
Outcome /
Measures
Results
Limitations
300 participants
selected from
geographical
diverse sample
of medical
claims data and
patients charts
between 1999 2005
Structured
interview
addressing self
reported
adherence,
experiences
with
medication,
communication
with physician
and healthrelated beliefs
associated
with
adherence.
Telephone
interviews
conducted with
Outcomes
Findings indicate
doctor-patient
communications/
relationships and
patient health
beliefs contribute
to adherence
8 variables
associated with
MPR:
1. hearing all info
from doctor
2. not believing
that reduced vision
is a risk of not
taking medication.
3. paying for
medications
4. difficulty while
travelling
5. not
acknowledging
stinging burning
6. being non white
7. receiving
None discussed but
see Friedman et al
(2007)
Male - 103
Female - 197
Age > 40 years
Full details
documented in
Friedman et al
(2007)
Measure
Medication
possession ratio
(MPR) primary
measure of
adherence i.e.
ration of days
supply of
medication
Recommendations
Physicians should
ensure that all
patients have an
understanding of
their disease that
supports
appropriate concern
about future
consequences.
patient
surveys
n = 300
ophthalmologis dispensed
ts.
divided by days
between
Full details
pharmacy
documented in fullfillments.
Friedman et al
(2007)
samples
8. not receiving a
phone call visit
reminder
Okeke CO, Quigley, Jampel HD, Ying G, Plyer RJ, Jiang Y, Friedman DS (2009) Interventions Improve Poor
Adherence with Once Daily Glaucoma Medications in Electronically Monitored Patients. Ophthalmology:
Journal of The American Academy of Ophthalmology Vol.116, No.12 2286-2293
Study
Purpose
& Type
To
investigate
the impact
of an
intervention
programme
to improve
adherence
with topical,
once daily
therapy for
glaucoma.
RCT
Sample
Intervention
Characteristics
Outcome
Measures
Results
Limitations
Recruited from
Glaucoma
services
Wilmer Eye
Inst.
And Scheie eye
Inst.
Multidimensional
ax carried out at
baseline and 3
months
significantly
increased
adherence
with
glaucoma
medications
(p < 0.001)
Despite randomised
process
intervention group
were more
experienced using
eye drops and had
low adherence
rates at baseline
Female: 17
Male: 18
n = 35 interv.
n = 31 control
Phase 1 prospective
observational cohort
study of pt adherence to
travoprost for 3mths
Phase 2 pts with 75% of
fewer admin doses
random to either
intervention or control
group.
multifaceted intervention
administered by study
staff involving:
10 min. education video
stressing the importance
of regular drop taking,
structured discussion
with study coordinator,
use of a diary, reminder
phone calls once per
Outcomes
Change in drop
use adherence
determined by a
electronic
dosing aid (DA)
Measures
Lower IOP
DA
Patient's informed
they were being
monitored and
provided with drugs
at no cost
Recommendations
Further research is
needed to
determine which
week for 1st month then
every other week for 2
months, admin. of
questionnaire about drop
taking behaviour
Activation of audible and
visible alarms on DA
components of this
intervention are
most effective
Chen X, Chen Y, Sun X (2009) Notable role of glaucoma club on patients' knowledge of glaucoma Clinical and
Experimental Ophthalmology Vol.37 pp.590-594
Study Purpose
& Type
To assess how
general
glaucoma pts
understand
their disease
compared with
pts. from
Shanghai
Glaucoma Club
Sample
Characteristics
Recruited from
Shanghai
Glaucoma Club
and general
glaucoma pts.
Intervention
Male 144
Female 157
Age 58-73
Uni. 118
n=301
Control
Male 147
Female 167
Age 36-68
Uni. 83
n =314
Intervention
Questionnaire
consisting of 20
questions, content:
level of knowledge
on glaucoma,
medication
compliance,
lifestyle/habbits
Club offered
members activities
every 2 mths
including lectures on
glaucoma type, diet
and circadian
rhythms, traditional
Chinese medicine,
physical and mental
health
Outcome
Measures
Outcomes:
Significant
differences in
2 groups
regarding
basic
understanding
of glaucoma
Results
Limitations
Glaucoma club
offered
members better
medium to
improve pts
knowledge of
disease and
compliance (p
< 0.01)
None discussed
but unable to
generalise findings
as study conducted
in single city.
Recommendations
To ensure effective
therapeutic
outcomes an ‘open
and honest’
approach to
communication
techniques is
recommended
Budenz DL (2009) A Clinicians Guide to the Assessment and Management of Nonadherence in Glaucoma
Journal of The American Academy of Ophthalmology Vol.116, No.11 pp.S43-S47
Study
Sample
Purpose
Characteristics
& Type
To apply
n.a.
lessons
learned in the
treatment of
systemic
hypertension to
non adherence
in glaucoma
treatment
Intervention/Method Outcome
Measures
Results
Limitations
Article based on
authors clinical
experience and peer
reviewed research
Involving
empowering
patients
Simplifying
medication
regimes
Secondary
research. Expert
opinion only.
Verbal info
should be
reinforced with
written info
Multifaceted
and tailored
interventions
Recommendations
1. Proactive
approach from
clinicians
2. Use of patient
centred
approaches that
tailor interv. to
overcome
specific barriers
3. Combination of
intervention
methods
Use of nurses,
other
paramedical
staff to reinforce
education
messages
Training on drop
application
should be
ongoing
Education
ineffective when
used alone
Family or other
social support
Cook PF, Bremer RW, Ayala AJ, Kahook MY (2010) Feasibility of motivational interviewing delivered by a
glaucoma educator to improve medication adherence. Clinical Ophthalmology Vol. 4 pp 1091-1101
Study Purpose Sample
& Type
Characteristics
Pts from tertiary
Feasibility of
glaucoma clinics
the introduction in Denver USA
of a glaucoma
educator
Exclusion:
Inability to admin
eye drops,
cognitive
impairment,
>80% adherence
during 2mth run
in phase
Surgery within 6
mths
Intervention
motivational
interviewing,
participants
assigned to the
glaucoma
educator
received three
one to one
meetings and
three phone
calls, literature
was also
provided to
reinforce
learning.
Outcome
Measures
Medication
Event
Monitoring
System
(MEMS) caps
– electronic
device that
records the
time and date
a pill bottle is
opened.
Results
Limitations
Treatment
manual
designed
8 pts assigned
to glaucoma
educator
completed 2 of
6 planned
contacts and
50% (4/8)
completed 6
contacts. Pts
assigned to
glaucoma
educator
improved over
time in both
motivation and
adherence
Small sample size
Single clinic setting
2 participating ophth.
already aware of non
adherence problems
and committed to
finding solutions
Recommendations
Use of multiple
measures of
adherence
Future work should
compare participants'
results to a
randomised control
group