Communication About Glaucoma and Patient Outcomes

关于青光眼和患者结果的沟通

• 批准号: 7802823
• 负责人: Betsy Lynn Sleath
• 金额: $ 72.89万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-05-01 至 2013-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7802823
• 关键词: Adherence; Aftercare; Area; Blindness; Clinic; Communication; Drops; Eyedrops; Foundations; Glaucoma; Goals; Health Services Research; Individual; Intention; Intervention Studies; Interview; Logistic Regressions; Measures; Medical; Ophthalmologist; Ophthalmology; Outcome; Patients; Pharmaceutical Preparations; Physicians; Physiologic Intraocular Pressure; Provider; Recruitment Activity; Regimen; Research; Risk; Self Efficacy; Self Management; Stratification; Suspect Glaucomas; Symptoms; Techniques; Testing; United States; Videotape Recording; Visit; base; design; expectation; improved; medication compliance; neglect; public health relevance; skills; social cognitive theory; treatment adherence

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.

描述（由申请人提供）：在美国，9% 至 12% 的失明归因于青光眼。青光眼患者没有症状会增加这些患者不遵守治疗方案的风险。大约 50% 开始服用青光眼药物的人会在 6 个月内停药。关于青光眼及其治疗的提供者与患者的沟通可能是影响初始治疗依从性和持久性的关键因素。人们对医疗服务提供者与青光眼患者的沟通知之甚少。该项目的主要目的是检查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开始滴药后 8 个月内的药物依从性、药物持久性和眼压 (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）与患者共同制定目标，以及（c）增强患者的能力青光眼自我管理技能。我们的研究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以潜在地提高患者的自我效能、坚持意愿和结果预期，从而影响我们将测量的患者结果（药物依从性） 、持久性和 IOP）。六个眼科诊所将招募 30 名眼科医生及其眼科技术人员以及 420 名会说英语的新青光眼或青光眼疑似患者。我们将对医疗访问进行录像。在对就诊进行录像后，研究助理将立即对每位参与的患者进行访谈，对他们的滴眼液技术进行录像，并测量患者的眼压。患者的下一次就诊（通常发生在四到六周后）也将被录像，随后患者将接受采访。在第二次录像就诊后大约 6 个月将对患者进行随访和访谈，因此患者总共将被随访 8 个月。以医生作为分层变量的多元线性和逻辑回归将检查眼科医生和眼科技术人员的沟通如何与药物依从性和持久性、眼压、自我效能、结果预期、坚持意愿和滴眼技术相关。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，以确保改善患者的治疗结果。如果我们发现医疗就诊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眼压有关，那么我们就可以设计干预研究来测试改善青光眼就诊期间提供者和患者之间沟通的策略，这些策略可以很容易地应用于实践。公共卫生相关性：项目叙述提供者与患者关于青光眼及其治疗的沟通可能是影响初始治疗依从性和持久性的关键因素。人们对医患沟通知之甚少。该项目的主要目的是检查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开始滴药后 8 个月内的药物依从性、药物持久性和眼压。