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Editors Selection IGR 9-3

Medical Therapy: Effect of educational support on therapy

Comment by Paul Healey on:

26946 Preliminary survey of educational support for patients prescribed ocular hypotensive therapy, TA Gray; C Fenerty; R Harper et al., Eye, 2010; 24: 1777-1786

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Medications are the most common therapy for open-angle glaucoma and we have a wealth of evidence of their IOP lowering efficacy. But such evidence only translates to better outcomes if our patients actually take their eye drops. Adherence to medical therapy is universally poor in chronic asymptomatic diseases including glaucoma. This observational cohort study by Gray et al. (1960) aimed to evaluate the impact of educational support on patients' knowledge of glaucoma and adherence, in preparation for an intervention study.

Study participants were recruited from an English Eye outpatient clinic with diagnoses of glaucoma, ocular hypertension or glaucoma suspect. Some were already taking glaucoma medications; some were newly prescribed medications during the four-month study period and some completed the study without glaucoma drops ever being prescribed. Data were collected by structured observation and interview only for patients who used medications during the study period. Participants' knowledge of glaucoma and its management were scored. Of 186 patients approached, 174 (96%) participated. Data were collected on all 80 follow-up patients and 58 patients initiated on medication. Follow-up patients' glaucoma knowledge score was significantly higher than newly diagnosed patients but the median knowledge score for both groups was low. For newly prescribed patients, the depth of information given varied widely across clinics and individual clinicians. Higher scores were found in younger participants, those with higher educational qualifications and those with a family history of glaucoma.

Doctors are generally poor at recognizing poor adherence and realizing the benefits of patient knowledge to the therapeutic alliance between doctor and patient

There was a significant association between the educational support and the knowledge score for newly prescribed patients, but not follow-up patients. There were no standard questions to ascertain whether patients were adhering to their drop regimen. Only five (6%) follow-up patients admitted to a doctor that they omitted drops, yet 75 (94%) reported to the researcher that they missed drops, mostly due to forgetting.

The results of this study are not at all surprising, but nevertheless concerning. Clinical management environments and techniques vary widely across the globe. But a common feature is a focus on the interpretation of measurements and planning IOP lowering. Doctors are generally poor at recognizing poor adherence and realizing the benefits of patient knowledge to the therapeutic alliance between doctor and patient.

Rather than assume our patients are taking their prescribed therapy correctly, perhaps we should assume that they are not

Rather than assume our patients are taking their prescribed therapy correctly, perhaps we should assume that they are not.

Then we can ask ourselves what educational interventions might by therapeutic in our treatment of glaucoma.

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