Systematic review of educational interventions to improve glaucoma medication adherence: an update in 2015

Abstract

Purpose: To evaluate the current state of the research on educational interventions whose aim is to improve glaucoma medication adherence. Methods: A systematic review of Pubmed, Embase and CINAHL was conducted to identify research studies evaluating educational interventions to improve glaucoma medication adherence. Studies were included if the intervention was described, the outcomes assessed glaucoma medication adherence and the focus of the research was on adults with glaucoma. The search was conducted on June 2, 2015. Results: Seventeen studies were identified that met the inclusion criteria. These included nine randomized controlled trials and eight observational studies. Eight of the studies demonstrated an impact on glaucoma medication adherence, though their outcome measures were too heterogeneous to estimate a pooled effect size. Conclusion: The interventions that successfully improved glaucoma medication adherence used an adequate dose of face-to-face counseling to overcome barriers to health behavior change alongside education about glaucoma.

KEYWORDS:

• glaucoma
• adherence
• education
• counseling
• review

Acknowledgements

We would like to acknowledge the critical contributions of Gale Oren, MLIS (Librarian, Director of Henderson Library, Kellogg Eye Center, University of Michigan) and Marisa Conte, MLIS (Research and Data Informationist, University of Michigan) in conducting this systematic review.

Financial & competing interests disclosure

This work was supported by the Michigan Vision Clinician-Scientist Development Program K12EY022299 (PANC).The funding organization had no role in the design or conduct of this research. AL. Robin is on the scientific advisory board for Biolight and Aerie Pharmaceuticals and has stock options in Glaukos and Aerie. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Key issues

• In this systematic review, we found that approximately half of the 17 educational interventions had an impact on glaucoma medication adherence, and the successful interventions were more likely to include a counseling session with a health educator.

• The majority of studies (11/17) did not use behavioral theory to underpin their educational interventions while the majority of the successful interventions (5/8) did use behavioral theory. It will be important to use successful behavioral theories in designing interventions in the future.

• Studies were very heterogeneous in terms of their method of evaluating adherence; future research should use objective methods of measuring adherence such as medication refill data and electronic medication monitoring.

• The only study that provided longer-term support and longer-term follow-up (2 years) showed a positive impact on adherence. As adherence is a lifelong issue, additional studies evaluating the long-term impact of counseling and education on disease management are needed.