• Written By: Gail Schwartz, MD

    This prospective study found that a customized automated telephone intervention supported by print materials did not significantly improve treatment adherence in glaucoma patients.

    The Interactive Study to Increase Glaucoma Adherence to Treatment (I-SIGHT) was conducted to determine the efficacy of an automated, interactive, telephone-based health communication intervention accompanied by printed materials for improving glaucoma treatment adherence among patients in two hospital-based eye clinics.

    Setting up such a system can certainly be difficult, but ever-changing technologies could produce a set of automated messages that may cover the individual issues for a majority of patients.

    Subjects were 312 glaucoma patients considered nonadherent because they did not take their medication, refill their medication, and/or keep their appointments. The treatment group received a tailored telephone intervention and tailored printed materials. The control group received standard care, including the recommendation for medical appointments and prescription refills on a physician-prescribed schedule.

    There were no significant differences between the treatment and control groups in background characteristics. The majority of participants were black and of low socioeconomic and educational status. One flaw of the study is the limited demographic; the overwhelming majority of patients were black males.

    The telephone intervention consisted of 12 educational telephone calls over a nine-month period. The printed materials-one-page, double-sided flyers written in large print at an eighth-grade reading level-were designed to reinforce tips and strategies to improve treatment adherence, provide additional glaucoma information, and be easy to review and reference at the participant's convenience. They were mailed one week after completion of a telephone call.

    The patients were assessed for: self-reported medication adherence, self-reported refill adherence, self-reported appointment adherence, chart report medication adherence, chart report refill adherence, and chart report appointment adherence.

    A statistically significant increase for all adherence measures was noted in both the treatment group and the control group. The treatment group had greater improvements in adherence in four of six categories, but this did not reach statistical significance.

    The authors write that although it is possible that the adherence measures chosen and piloted for this study were too insensitive to capture a modest treatment effect, it is difficult to explain the statistically significant effect in the control group without questioning whether other study-related factors accounted for the changes. There may have been a selection bias that contributed to a placebo effect in the control group. Also, the control patients may have already been highly motivated to seek further knowledge or involvement in managing their glaucoma.

    Further study of interventions is clearly necessary.