Tailored care improves medication adherence in glaucoma patients

Personalized care appears to increase adherence to medications among patients with glaucoma relative to standard of care (SOC), suggests a recent study, adding that a multifaceted approach may result in further improvements.

The databases of PubMed, Embase, Scopus, the Cochrane Central Register of Controlled Trials, the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov were searched on 30 November 2021 for randomized controlled trials (RCTs) exploring interventions for improved adherence to ocular hypotensive therapy.

A team of investigators conducted a network meta-analysis (NMA) and compared the following interventions: SOC (control), short message service, telephone call, device reminder, motivational interview, multimedia education, physician education, provision of own medical records, incentives, tailored care, and enhanced SOC.

Mean adherence score postintervention was the primary outcome. The investigators analysed the standardized mean differences (SMDs) and ranked the effectiveness by p-score (probability of being the best treatment). They assessed the trials using the Cochrane risk-of-bias tool for RCTs and the certainty of results by Confidence in Network Meta-analysis.

Nineteen RCTs including 4,981 participants met the eligibility criteria. Tailored care, including face-to-face needs assessment and a personalized care plan, improved adherence better than SOC (SMD, 1.28, 95 percent confidence interval [CI], 0.08‒2.48; p=0.810).

Multifaceted interventions that included tailored care demonstrated additional improvement in adherence: tailored care + multimedia education (SMD, 1.44, 95 percent CI, 0.20‒2.67; p=0.850) and tailored care + multimedia education + device reminder (SMD, 1.61, 95 percent CI, 0.75‒2.47; p=0.914).

The remaining interventions ranked according to p-scores were as follows: incentives (p=0.606), short message service (p=0.535), enhanced SOC (p=0.458), multimedia education (p=0.430), device reminder (p=0.429), telephone call (p=0.401), provision of own medical records (p=0.391), physician education (p=0.281), SOC (p=0.230), and motivational interview (p=0.165).

“High adherence to ocular hypotensive therapy is essential for prevention of visual impairment in glaucoma patients,” the investigators said.