Interventions for improving adherence to ocular hypotensive therapy

  • Review
  • Intervention

Authors


Abstract

Background

Poor adherence to therapy is a significant healthcare issue, particularly in patients with chronic disease such as open angle glaucoma. Treatment failure may necessitate unwarranted changes of medications, increased healthcare expenditure and risk to the patient if surgical intervention is required. Simplifying eye drop regimes, providing adequate information and ongoing support according to patient need, may have a positive effect on improving adherence.

Objectives

To summarise the effects of interventions for improving adherence to ocular hypotensive therapy in people with ocular hypertension (OHT) or glaucoma.

Search methods

We searched CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, ZETOC and OpenSIGLE. In addition, we searched research registers of ongoing studies. We contacted pharmaceutical manufacturers to request unpublished data and searched conference proceedings for the Association for Research in Vision and Ophthalmology (ARVO), and the Annual Congress for the Royal College of Ophthalmologists (RCO). There were no language or date restrictions in the search for trials. The electronic databases were last searched on 15 January 2009.

Selection criteria

We included randomised controlled trials (RCTs) and quasi RCTs that compared interventions to improve adherence to ocular hypotensive therapy for patients with OHT or glaucoma.

Data collection and analysis

At least two authors independently assessed the search results for eligibility and extracted data for included trials onto specifically designed forms. We calculated the mean difference for continuous data and relative risks for dichotomous data. Where appropriate, we pooled data using a fixed-effect model.

Main results

Eight trials met the inclusion criteria. There was considerable heterogeneity of interventions and reported outcome measures and therefore, meta-analysis was limited to two studies. Overall, studies were not of high quality due to small sample sizes, missing data and short term follow-up. Three of five drug comparison studies provided evidence that reducing the frequency of drops can improve adherence. However, the study that compared the least frequent regime with one of the most complicated, showed no difference in reported adherence. A small study of thirteen patients found a reminder device beneficial to adherence levels yet only one of two studies involving education and individualised care planning was found to be successful.

Authors' conclusions

Interventions involving simplified dosing regimes, reminder devices, education and individualised care planning, did show improvements in adherence rates. However, due to inadequate methodological quality and heterogeneity of study design we are unable to advocate any particular interventions at this time.

摘要

背景

促進降眼壓治療之順從性的介入措施

治療的順從性不佳是一項重要的健康照護議題,尤其是慢性病的病患如廣角性青光眼。治療失敗也許會造成無端的改變用藥,如果需要手術介入的話,會增加健康照護支出與病患風險。依據病患的需要簡化眼睛滴劑的處置,提供適當的資訊與持續的支持,也許對於促進順從性會有正面的影響。

目標

總結促進高眼壓(ocular hypertension (OHT))或青光眼患者順從降眼壓治療之介入措施的影響。

搜尋策略

我們搜尋了CENTRAL,MEDLINE,EMBASE,CINAHL,PsycINFO,Web of Science,ZETOC及OpenSIGLE。此外,我們還搜尋了正在進行中的研究清單。我們聯絡藥廠以尋求未發表的資料,並搜尋the Association for Research in Vision and Ophthalmology (ARVO,與the Annual Congress for the Royal College of Ophthalmologists (RCO)的會議記錄。檢索條件不限制語言或日期。最近一次搜尋電子資料庫是在2009年1月15日。

選擇標準

我們納入比較促進高眼壓或青光眼患者順從降眼壓治療之介入措施的隨機對照試驗(randomised controlled trials (RCTs))與類隨機對照試驗。

資料收集與分析

至少有兩名作者分別評估研究結果的合格性並摘錄試驗資料到特定的格式中。我們計算連續資料的平均差以及二分資料的相對風險。如果合適的話,我們採用固定效果模式加總資料。

主要結論

有八篇試驗符合納入標準。介入措施與測量結果具有相當大的異質性,因此,統合分析只限於兩篇研究。整體來說,由於樣本小,遺漏資料與追蹤時間短,因此研究品質不佳。五篇藥物比較的研究中有三篇提供了減少滴劑次數可以促進順從性的證據。然而,比較最不頻繁與最複雜的處置,研究顯示順從性沒有差異。一篇有13名病患的小型研究發現,提醒裝置有利於順從程度,但發現關於教育與個別化照護計畫的兩篇研究中只有其中一篇成功。

作者結論

顯示關於簡化劑量的處置,提醒裝置,教育與規劃個別化照護的介入措施可以改善順從率。然而,由於方法學品質不佳且研究設計具有異質性,因此這個時候我們無法提倡任何特定的介入措施。

翻譯人

本摘要由高雄榮民總醫院金沁琳翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

許多人不按照處方來使用眼睛滴劑。青光眼是一種慢性進展的眼疾,它會造成嚴重的視力損失。用於高眼壓或青光眼的滴劑,目的在降低眼壓以協助減少進展率,或預防高眼壓轉變為青光眼。重要的是要持續地使用這些眼睛滴劑,通常需使用一輩子。第一次使用眼睛滴劑的人中,有將近70%的人在第一年內沒有持續進行治療,即使有進行治療,但他們並未依照應使用的次數來使用滴劑。這可能有許多原因,例如,健忘,使用了大量的藥物,滴入滴劑有困難,生活忙碌以及認為無效。這篇回顧是根據八篇研究,試驗不同的方法以幫助民眾依據處方使用滴劑。包括以下的介入措施;簡化滴劑的例程,提醒裝置,提供青光眼的資訊並對眼睛照護的日常問題給予建議。八篇中有五篇研究顯示這些介入措施有助於民眾確實地使用眼睛滴劑。遺憾的是,並非所有的研究皆具高品質,因此除非有更多的證據,否則我們不能建議任何特定的方法。這個研究領域需要品質良好的研究以更確切的了解病患的個人需要,並有助於我們提供更有效的眼睛照護服務。

Plain language summary

Interventions for helping people use eye drops as prescribed for raised eye pressure or glaucoma

A large number of people do not use eye drops as prescribed. Glaucoma is a slowly progressive eye disease, which can result in severe vision loss. Drops prescribed for raised eye pressure or glaucoma are aimed at lowering the pressure to assist in reducing the rate of progression, or preventing the conversion of raised eye pressure to glaucoma. It is important that these eye drops are used continually, usually for life. Approximately 70% of people who are prescribed eye drops for the first time, fail to continue collecting prescriptions within the first year and even when patients collect prescriptions they do not always use the drops as frequently as they should. A number of reasons are thought to be the cause, for example, forgetfulness, being prescribed a large number of medications, difficulties instilling drops, a busy lifestyle and seeing no benefit.

This review is based on eight studies that tried out different methods to help people to use drops as prescribed. The following interventions were included; simplifying drop routines, reminder devices, providing information about glaucoma and offering advice regarding day to day issues with eye care. Five of the eight studies showed that these interventions helped people take their eye drops reliably. Unfortunately, not all of these studies were of high quality and, therefore, until more evidence is available we cannot recommend any particular method. Good quality research is needed in this area in order to develop a better understanding of patients' individual needs and to help us provide more effective eye care services.

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