Enhancing Glaucoma Medication Adherence Among African Americans

提高非裔美国人青光眼药物的依从性

基本信息

批准号：
9070592
负责人：
LAURA E DREER
金额：
$ 36.75万
依托单位：
UNIVERSITY OF ALABAMA AT BIRMINGHAM
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-06-01 至 2020-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9070592
关键词：
21 year old Address Adherence Adult African American Alabama Area Awareness Behavior Belief Blindness Caring Caucasians Clinic Clinical Trials Design Control Groups Conventional Surgery Data Deterioration Diagnosis Disease Management Disease Progression Dose Education Effectiveness of Interventions Electronics Elements Eligibility Determination Expenditure Eye Eye diseases Eyedrops Family Focus Groups Future Generations Glaucoma Goals Health Health Promotion Healthcare Individual Informed Consent Intervention Interviewer Journals Knowledge Language Lasers Life Literature Masks Measures Medical Medicine Onset of illness Operative Surgical Procedures Ophthalmology Optometry Paper Patient Education Patients Perception Pharmaceutical Preparations Population Preparation Prevalence Problem Solving Process Provider Publishing Quality of life Race Randomized Randomized Clinical Trials Readiness Research Research Design Risk Sample Size Schedule Services Socioeconomic Factors Test Result Testing Time Trabeculectomy Training Treatment Cost Treatment Efficacy Underserved Population Universities Vision Visit Writing arm base blind community based participatory research coping design emotional distress empowerment experience follow-up health disparity healthy lifestyle high risk improved interest medication compliance motivational enhancement therapy patient population pressure prevent primary outcome programs racial difference secondary outcome skills socioeconomics therapy development treatment as usual treatment group vision science

项目摘要

DESCRIPTION (provided by applicant): Glaucoma is the leading cause of irreversible blindness among African Americans (AA) who are more than three times more likely to develop glaucoma when compared to Caucasians. Changes associated with the progression of glaucoma can have a serious negative impact on an individual's quality of life, independence, and everyday functioning. Accumulating research indicates that pressure-reducing eye drops can significantly delay or prevent the onset of disease; however, such preventative efforts have been found to be limited due to problems with poor medication adherence. Lacking are available health promotion interventions that minimize this important health disparity. Thus, in our research program, we demonstrated this health disparity for glaucoma medication adherence (Dreer et al., 2012). Next, we conducted several follow-up studies in order to develop a culturally relevant and informed, health promotion-based intervention to improve glaucoma medication adherence among AA's. As part of the intervention development process, we conducted several focus groups with AA glaucoma patients to elicit the salient barriers and facilitators related to glaucoma medication adherence, and then formed a community-based participatory research team comprised of AA's with glaucoma (Dreer et al., 2013). The resulting intervention was based on a multi-component empowerment framework that includes glaucoma education, motivational interviewing, and problem-solving training to improve glaucoma medication adherence. We recently pilot tested the feasibility and preliminary efficacy of the intervention among AA's. Findings revealed significant improvements in objective medication adherence (Dreer et al., under review). Therefore, we now propose to further evaluate the efficacy of this intervention for improving glaucoma medication adherence among AA patients in a large-scale randomized clinical trial (RCT). The patient population for the RCT will consist of 240 adult AA's with glaucoma and who are aged = 21 years who seek services at the University of Alabama at Birmingham's Glaucoma Clinic within the Department of Ophthalmology. The RCT will have two treatment arms; patients will be randomized following eligibility determination and written informed consent. The usual care only arm will consist of the standard medical care for glaucoma (medicine, laser trabeculoplasty, conventional surgery, or a combination of any of these). The second arm will consist of usual care as just described plus the culturally relevant, health promotion-based intervention. The primary outcome (objective glaucoma medication adherence) and secondary outcomes will be assessed at baseline before intervention initiation and at 3, 7, and 12-month in-clinic follow-up visits by a research interviewer masked to subjects' randomization. The practical question to be addressed is does a culturally relevant, health promotion-based intervention improve glaucoma medication adherence among a high-risk segment of the population? Information from this project will be particularly useful for AA's with glaucoma, their families, and eye care providers.

描述（由适用提供）：青光眼是非洲裔美国人（AA）不可逆失明的主要原因，与高加索人相比，发展青光眼的可能性高三倍以上。与青光眼发展相关的变化可能会对个人的生活质量，独立性和每天运作产生严重的负面影响。累积研究表明，减压眼滴可以显着延迟或阻止疾病的发作。但是，由于药物依从性差的问题，这种预防努力受到限制。缺乏可用的健康促进干预措施，可以最大程度地减少这种重要的健康差异。在我们的研究计划中，我们证明了青光眼药物依从性的健康差异（Dreer等，2012）。接下来，我们进行了几项后续研究，以开发一种具有文化相关和知情的，基于健康的促进干预措施，以改善AA的青光眼药物依从性。作为干预开发过程的一部分，我们与AA青光眼患者进行了几个焦点小组，以引起与青光眼药物依从性相关的显着障碍和促进剂，然后组成了一个基于社区的参与研究团队，与青光眼一起完成了AA（Dreer等人，2013年）。最终的干预措施是基于多组分的授权框架，其中包括青光眼教育，动机访谈和解决问题的培训，以改善青光眼药物的依从性。我们最近试行测试了AA干预措施的可行性和初步效果。研究结果表明，客观药物依从性有显着改善（Dreer等人，正在审查中）。因此，我们现在建议进一步评估该干预措施在大规模随机临床试验（RCT）中改善AA患者中青光眼药物依从性的效率。 RCT的患者群体将由240个成人AA组成，= 21岁，他们在阿拉巴马大学在伯明翰的青光眼诊所在Ophthalmology系的阿拉巴马大学寻求服务。 RCT将有两个治疗臂；在确定资格确定并书面知情同意书后，患者将随机分组。通常的护理仅由青光眼的标准医疗护理（药物，激光小梁成形术，常规手术或其中任何一个组合）组成。第二组将包括通常的护理，如刚刚描述的，以及与文化相关的，基于健康促进的干预措施。在干预计划之前，将在基线和第3、7和12个月的临界后随访访问之前评估主要结果（客观的青光眼药物依从性）和次要结果，该研究访问者掩盖了受试者随机化的研究访问者。要解决的实际问题是，基于健康的，基于健康促进的干预措施是否可以改善高风险人群中的青光眼药物依从性？该项目的信息对于与青光眼，他们的家人和眼部护理提供者的AA特别有用。