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  • Tailored Care Improves Adherence to Glaucoma Therapy

    By Lynda Seminara
    Selected by Russell N. Van Gelder, MD, PhD
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    Journal Highlights

    Ophthalmology, November 2022

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    Although many efforts to improve medication adherence in patients with glaucoma have been proposed, evi­dence of their relative effectiveness is lacking. Ha et al. conducted a network meta-analysis of randomized con­trolled trials (RCTs) to compare effec­tiveness for various interventions. They found that tailored care that included a face-to-face needs assessment and a personalized care plan was superior to standard of care (SOC) for improving adherence rates. When tailored care was combined with other initiatives, such as reminder devices and multimedia education, adherence improved even further.

    For this work, the authors searched multiple databases to identify RCTs of strategies to improve medication adherence among adults with glauco­ma or ocular hypertension. They then compared the efficacy of 11 interven­tions alone or in combination: basic SOC (control), enhanced SOC, short message service (SMS), telephone call, device reminder, incentives, motiva­tional interview, multimedia education, physician education, tailored care, and provision of own medical records. Enhanced SOC was defined as basic SOC plus additional support, such as providing printed information. The main outcome measure was the mean adherence score following intervention. The standardized mean differences (SMDs) were analyzed by a random-effects model, and effectiveness was ranked by p score (the probability of being the best intervention).

    Nineteen RCTs, representing 4,981 patients, qualified for the analysis. Tailored care, which in­cluded an in-person needs assessment and personalized care plan, was better than SOC for improving therapy adherence (SMD, 1.28; p = .810). Multifaceted interven­tions that included tailored care improved adherence even further: tailored care + multimedia education (SMD, 1.44; p = .850) and tailored care + multimedia education + device remind­er (SMD, 1.6; p = .914). P scores (highest to lowest) for the other interventions were .606 for incentives, .535 for SMS, .458 for enhanced SOC, .430 for device reminder, .429 for mul­timedia education, .401 for telephone call, .391 for provision of own medical records, .281 for physician education, .230 for general SOC, and .165 for motivational interview.

    Findings of this meta-analysis sug­gest that adherence to glaucoma med­ication is better with tailored care than with standard care. “A multifaceted ap­proach might yield additional improve­ments,” said the authors. They empha­sized that a personalized approach may reduce barriers to adherence.

    The original article can be found here.