0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation |

Automated Telecommunication-Based Reminders and Adherence With Once-Daily Glaucoma Medication Dosing:  The Automated Dosing Reminder Study

Michael V. Boland, MD, PhD1,2; Dolly S. Chang, MD, PhD1,3; Travis Frazier, MD4; Ryan Plyler, BS5; Joan L. Jefferys, ScM3; David S. Friedman, MD, MPH, PhD1,3
[+] Author Affiliations
1Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
2Division of Health Sciences Informatics, The Johns Hopkins University School of Medicine, Baltimore, Maryland
3Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
4Madigan Army Medical Center, Fort Lewis, Washington
5Georgetown University School of Medicine, Washington, DC
JAMA Ophthalmol. 2014;132(7):845-850. doi:10.1001/jamaophthalmol.2014.857.
Text Size: A A A
Published online

Importance  Topical glaucoma medications lower intraocular pressure and alter the course of the disease. Because adherence with glaucoma medications is a known problem, interventions are needed to help those patients who do not take their medications as prescribed.

Objective  To assess the ability of an automated telecommunication-based intervention to improve adherence with glaucoma medications.

Design, Setting, and Participants  We performed a prospective cohort study of medication adherence, followed by a randomized intervention for those found to be nonadherent, of individuals recruited from a university-based glaucoma subspecialty clinic. A total of 491 participants were enrolled in the initial assessment of adherence. Of those, 70 were nonadherent with their medications after 3 months of electronic monitoring and randomized to intervention and control groups.

Interventions  A personal health record was used to store the list of patient medications and reminder preferences. On the basis of those data, participants randomized to the intervention received daily messages, either text or voice, reminding them to take their medication. Participants randomized to the control group received usual care.

Main Outcomes and Measures  Difference in adherence before and after initiation of the intervention.

Results  Using an intent-to-treat analysis, we found that the median adherence rate in the 38 participants randomized to the intervention increased from 53% to 64% (P < .05). There was no statistical change in 32 participants in the control group. To assess the real efficacy of the intervention, the same comparison was performed for the participants who successfully completed the study after randomization. Analyzed this way, the adherence rate in the 20 participants in the intervention group increased from 54% to 73% (P < .05), whereas there was again no statistical change in the 19 participants in the control group. Eighty-four percent of the participants who received reminders agreed they were helpful and would continue using them outside the study.

Conclusions and Relevance  Automated telecommunication-based reminders linked to data in a personal health record improved adherence with once-daily glaucoma medications. This is an effective method to improve adherence that could realistically be implemented in ophthalmology practices with a minimum amount of effort on the part of the practice or the patient.

Figures in this Article

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

Figures

Place holder to copy figure label and caption
Figure 1.
Specification of an Automated Reminder to Be Associated With a Particular Medication Using the Custom HealthVault Application

Reminder information was sent securely to Memotext, where the reminders were actually generated.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Flow of Participants Through the Study
Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.
Change in Adherence

Distribution of changes in adherence for the control and intervention groups between the 3- and 6-month study visits for participants completing all phases of the study. Change in adherence is defined as the final (6-month visit) adherence minus the initial (3-month visit) adherence. The count in a particular bin includes values of adherence change less than or equal to the value of the midpoint to the right and greater than the midpoint to the left (ie, the bars between −20 and 0 include no change).

Graphic Jump Location

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
Jobs
brightcove.createExperiences();