Tailored care for patients with glaucoma, including the applications of a face-to-face needs assessment and personalized care plan, can improve medication adherence, according to a network meta-analysis (NMA) published in Ophthalmology.
Investigators reviewed data from 4981 participants of 19 randomized controlled trials examining ocular hypotensive therapy outcomes.
The researchers examined a plethora of interventions designed to improve compliance and analyzed standardized mean differences (SMD) between them. Strategies evaluated and mean SMDs included:
- Tailored care, 1.28
- Incentives, 0.71
- Short message service (SMS), 0.50
- Enhanced standard of care (printed information added), 0.35
- Device reminder, 0.31
- Multimedia education, 0.31
- Telephone call, 0.25
- Providing patient their own medical records, 0.23
- Physical education, -0.02
- Motivational interview, -0.26
Tailored care was the standout, yet, if multimedia education and device reminder was added, benefits were even greater. Personalized care reached 1.28 mean SMD, therefore a POB of 81.7% likelihood the patient will more diligently follow a regimen than with SOC. Tailored care plus multimedia scored an SMD of 1.44, POB 84.6%; and all 3 strategies as a multi-faceted technique achieved SMD at 1.61, POB 87.3%, the study shows. Other interventions showed less efficacy, with physical education and motivational interviews demonstrating the least improvement.
Prior research shows most patients with low adherence experience several challenges sticking with their therapy; thus supportive help for each obstacle may be crucial, the investigators explain. “The present NMA suggested that patient-tailored intervention with individualized counseling, delivered in person to address each patient’s problems, was more effective than a standardized approach,” according to the study authors.
The secondary measure for this analysis was intraocular pressure (IOP) change. Seven studies assessed IOP, comprising 6 of the interventions: educational multimedia, incentives, motivational interview, providing own medical records, SMS, and tailored care. None of the methods significantly improved IOP in relation to SOC.
Limiting this meta-analysis was the diversity in adherence measurement, therefore investigators advise caution in the NMAs results. Also, trials with smaller samples may have prompted publication bias or indicated a larger treatment effect. Conversely, strengths involved casting a large net for evidence, and employing NMA — an extension of traditional meta-analysis that allows more direct comparative evaluation among various interventions.
Ha A, Jang M, Shim SR, et al. Interventions for glaucoma medication adherence improvement: a network meta-analysis of randomized controlled trials. J Ophthalmol. August 23, 2022;16:2803–2812. doi:10.1016/j.ophtha.2022.06.025