Glaucoma Medication Adherence One Year After the Support, Educate, Empower (SEE) Personalized Glaucoma Coaching Program

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Ophthalmol Glaucoma


PURPOSE: To assess the efficacy of the Support, Educate, Empower (SEE) glaucoma coaching program on medication adherence among poorly adherent glaucoma patients for 12 months following cessation of the intervention.

DESIGN: Uncontrolled intervention study with a pre-post design.

PARTICIPANTS: The SEE cohort was recruited from the University of Michigan and included glaucoma patients age ≥ 40, taking ≥ 1 medication, who self-reported poor adherence. Electronic medication monitoring of those who completed the program continued for up to 1-year post-coaching intervention.

METHODS: Adherence was monitored electronically (AdhereTech, New York, NY) during the 7-month program and 12-month follow up period. Adherence was the percentage of doses taken on time. Participants were censored for surgery, change in glaucoma medications or adherence monitor disuse. The SEE program included automated medication reminders, three in-person motivational interviewing-based counseling sessions with a glaucoma coach, and five phone calls with the coach for between-session support. There was no contact between the study team and participants during the 12-month post-program cessation follow-up. Baseline participant characteristics were summarized with descriptive statistics. Paired t-tests and Wilcoxon signed rank tests were used to investigate significant changes in monthly adherence during follow-up.

MAIN OUTCOME MEASURES: Change in electronically monitored medication adherence over the 12 months following the conclusion of the SEE program. RESULTS: Out of 48 participants, 39 (81%) completed the SEE program and continued electronic medication monitoring for up to 1-year after program cessation. Participants were on average 64 years old (SD=10), 56% were male, 49% were Black, and 44% were White. The average length of follow-up was 284 days (SD=110, range= 41 to 365 days). Censoring occurred in 18 participants (56%). Average adherence during the follow-up period was 67% (SD=22%). This was significantly lower than adherence during the SEE program (mean=81%, SD=18%, p<0.0001), but significantly higher than baseline pre-program adherence (mean=60%, SD=18%, p=0.0393). The largest monthly losses occurred at months 1 (mean=7%, p=0.0001) and 4 (mean=6%, p=0.0077).

CONCLUSIONS: Glaucoma medication adherence decreased significantly in the year after cessation of the SEE coaching program but remained significantly higher than baseline. To maintain excellent long-term medication adherence, intermittent reinforcement sessions may be necessary.

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ePub ahead of print