Access to and Experiences with, e-Health Technology Among Glaucoma Patients and Their Relationship with Medication Adherence

Analysis of the Readability and Accountability of Online Patient Education Materials Related to Glaucoma Diagnosis and Treatment

Purpose

To assess the readability and accountability of online patient education materials related to glaucoma diagnosis and treatment.

Methods

We conducted a Google search for 10 search terms related to glaucoma diagnosis and 10 search terms related to glaucoma treatment. For each search term, the first 10 patient education websites populated after Google search were assessed for readability and accountability. Readability was assessed using five validated measures: Flesch Reading Ease (FRE), Gunning Fog Index (GFI), Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), and New Dale-Chall (NDC). Accountability was assessed using the Journal of the American Medical Association (JAMA) benchmarks. The source of information for each article analyzed was recorded.

Results

Of the 200 total websites analyzed, only 11% were written at or below the recommended 6th grade reading level. The average FRE and grade level for 100 glaucoma diagnosis-related articles were 42.02 ± 1.08 and 10.53 ± 1.30, respectively. The average FRE and grade level for 100 glaucoma treatment-related articles were 43.86 ± 1.01 and 11.29 ± 1.54, respectively. Crowdsourced articles were written at the highest average grade level (12.32 ± 0.78), followed by articles written by private practice/independent users (11.22 ± 1.74), national organizations (10.92 ± 1.24), and educational institutions (10.33 ± 1.35). Websites averaged 1.12 ± 1.15 of 4 JAMA accountability metrics.

Conclusion

Despite wide variation in the readability and accountability of online patient education materials related to glaucoma diagnosis and treatment, patient education materials are consistently written at levels above the recommended reading level and often lack accountability. Articles from educational institutions and national organizations were often written at lower reading levels but are less frequently encountered after Google search. There is a need for accurate and understandable online information that glaucoma patients can use to inform decisions about their eye health.

Medication Adherence and Common Barriers for Caregivers of Preschool Children with Pediatric Glaucoma

Purpose. To investigate the medication adherence among caregivers of preschool children with pediatric glaucoma and to elucidate common barriers leading to poor adherence. Methods. A cross-sectional study. Caregivers of preschool children with pediatric glaucoma completed a questionnaire on demographic information of caregivers, demographic and disease characteristics of children, caregivers-reported medication adherence (by an adapted Morisky Adherence Scale), and possible 13 barriers. Results. Overall 132 questionnaires were considered valid. Thirty-six percent of all reported poor medication adherence. Caregivers’ age and self-evaluated knowledge about pediatric glaucoma showed a significant difference between the adherent and nonadherent groups ( $P<0.05$ ). Nineteen percent of all reported only one barrier as important, 65% cited multiple barriers, and 16% cited no barriers. Anxiety and depression were cited as important by most caregivers in both groups. Univariate logistic regression analysis demonstrated that difficulty with the acquisition of medications (OR, 2.5; 95% CI, 1.1–5.7; $P=0.025$ ), difficulty with medication schedule (OR, 2.3; 95% CI, 1.0–5.0; $P=0.043$ ), and high expenses for medications (OR, 4.8; 95% CI, 1.4–15.9; $P=0.011$ ) were significantly associated with higher odds of poor adherence. Conclusions. Over one-third of caregivers of preschool children with pediatric glaucoma were in poor medication adherence. Nearly two-thirds of caregivers cited multiple barriers simultaneously as important hindrances to medication usage. Anxiety and depression, difficulty with the acquisition of medications, difficulty with the medication schedule, and high expenses for medications were prominent barriers. Individualized solutions should be provided according to reported barriers by each caregiver and the other most common barriers.

The Effectiveness of Interactive Patient Education on Adherence to Leprosy Medications in an Ambulatory Care Setting Indonesia: A Randomized Control Trial

BACKGROUND: Poor treatment adherence has been linked to recurrence and the development of antibiotic resistance in leprosy patients. Previous research has shown that structured health education programs improve treatment adherence in other patients, but similar research in leprosy patients is lacking. AIM: This study aimed to assess the effect of interactive patient education on adherence to leprosy medications in an ambulatory care setting in Indonesia. METHODS: A randomized controlled trial (RCT) was conducted between January and April 2021. The research was conducted at a public health center in West Papua, Indonesia. This RCT employed 1:1 randomization to allocate participants to one of two groups. Eligibility criteria included those aged over 18 years old and diagnosed with leprosy at least 6 months. An interactive patient education program included four intervention steps that lasted 1 month, with four sessions lasting 60–90 min each week. The Morisky Medication Adherence Scale was used to assess medication adherence. The difference-in-differences technique was used to evaluate the variances between T0 and T1 and T0 for the intervention versus control groups (DID). RESULTS: Approximately, 200 participants agreed to join in this study (response rate = 72.5%). An interactive patient education program improved outcomes relative to the control at T1; medication adherence increased 0.11 (95% CI 0.01–0.25). At T2, improved outcomes relative to the control were observed in medication adherence (DID coefficient 0.31 (95% CI 0.10–0.59). CONCLUSIONS: This study demonstrates that an interactive patient education program could effectively enhance medication adherence. Therefore, it is advised that health care professionals working with leprosy patients participate in the development of patient education programs and establish therapeutic partnerships with their patients.

Association between online health information-seeking and medication adherence: A systematic review and meta-analysis

Background

The evidence of the impact of online health information-seeking (OHIS) on health outcomes has been conflicting. OHIS is increasingly recognised as a factor influencing health behaviour but the impact of OHIS on medication adherence remains unclear.

Objectives

We conducted a systematic review and meta-analysis to examine the associations between OHIS and medication adherence.

Methods

We searched Medline, Embase, Web of Science, Scopus, CINAHL and Psychology and Behavioural Science Collection for studies published up to December 2020. The inclusion criteria were studies that reported the associations of OHIS and medication adherence, quantitative design, reported primary data only, related to any health condition where medications are used and conducted on patients either in clinical or community settings. A meta-analysis was used to examine the association between OHIS and medication adherence.

Results

A total of 17 studies involving 24,890 patients were included in this review. The study designs and results were mixed. In the meta-analysis, there was no significant association (n = 7, OR 1.356, 95% CI 0.793-2.322, p = 0.265), or correlation (n = 4, r = -0.085, 95% CI −0.572-0.446, p = 0.768) between OHIS and medication adherence. In the sub-group analysis of people living with HIV/AIDS, OHIS was associated with better medication adherence (OR 1.612, 95% CI 1.266-2.054, p < 0.001).

Conclusions

The current evidence of an association between OHIS and medication adherence is inconclusive. This review highlights methodological issues on how to measure OHIS objectively and calls for in-depth exploration of how OHIS affects health decisions and behaviour.

Internet Search Engine Queries of Common Causes of Blindness and Low Vision in the United States

PURPOSE

To characterize Internet search engine patterns of American Internet users for common causes of blindness and low vision.

DESIGN

A retrospective cross-sectional study.

METHODS

Retrospective analysis with publicly available Google trends data from January 1, 2004, to January 1, 2020, using Google search engine.

PATIENT POPULATION

Random sample of US and worldwide Internet users who searched for information on the topics of cataract, macular degeneration, glaucoma, diabetic retinopathy, and near-sightedness using the Google search engine.

MAIN OUTCOME MEASURES

Percentage of searches related to disease and treatment education for each condition.

RESULTS

Cataract searches most commonly pertain to treatment education (72.3%) and disease education (23.6%). Glaucoma, macular degeneration, and near-sightedness searches more commonly pertained to disease education (69.5%, 64.0%, 50.4% respectively) than treatment education (18.4%, 17.9%, 10.7% respectively). Diabetic retinopathy searches related to other diseases (41.5%), followed by disease education (33.5%) and treatment education (8.2%). Mean relative search frequency (RSF) values for queries were 66.7 ± 13.3, 58.6 ± 6.2, 33.3 ± 6.7, 29.2 ± 6.5, and 8.6 ± 1.4 for cataract, glaucoma, near-sightedness, diabetic retinopathy, and macular degeneration, respectively, with all pairwise comparisons yielding statistically significant values (P < .001). RSF was found to be fairly well correlated with North American blindness prevalence by condition (r² = 0.5898).

CONCLUSION

The search results of American Internet search users yield information on disease basics or treatment education for the disease. The most commonly searched queries for each condition yield different types of information with cataract queries presenting more commonly with treatment information. These results may inform future patient education practices.

Marijuana and Glaucoma: A Social Media Content Analysis

PURPOSE

This study analyzes the content quality and characteristics of the most popular and highly ranked search results on the internet related to glaucoma and medical cannabis (MC).

DESIGN

Internet-based, cross-sectional study.

PARTICIPANTS

Not applicable.

METHODS

Google and 2 social media platforms (Facebook, YouTube) were used to identify online information most accessible to patients. Search criteria included "glaucoma" AND "marijuana" or "cannabinoid" or "CBD." The top 20 Google search and YouTube results for each search term and the posts from the top 9 patient-based glaucoma Facebook groups were aggregated and analyzed using the search criteria.

MAIN OUTCOME MEASURES

The quality of the content was graded by 2 independent graders using a previously validated Sandvik score and previously reported risk score. The differing values were resolved by a final grader. Additional analysis included whether the source was professional (by physician or medical organization) or shared an opinion on MC (pro, mixed, or against) use in glaucoma.

RESULTS

This search resulted in an aggregate of 51 websites on Google, 126 posts from Facebook groups, and 37 videos on YouTube. The mean (± standard deviation) Sandvik score and risk score were 11.0 (±2.23), 10.2 (±1.12), 10.6 (±1.89) and 0.27 (±0.49), 0.46 (±0.62), 0.97 (±0.90) for Google, Facebook, and YouTube, respectively. Analysis of variance showed statistically significant differences in Sandvik (P = 0.01) and risk (P < 0.0001) scores across the 3 platforms. A significant portion of online material was pro-MC use in the setting of glaucoma (24% of Google, 59% of YouTube, and 21% of Facebook results). Professional content had a significantly higher content quality score and a lower risk score, and was less likely to recommend MC use in glaucoma.

CONCLUSIONS

Despite American Academy of Ophthalmology, Canadian Ophthalmological Society, and American Glaucoma Society statements against MC use in patients with glaucoma, a significant portion of online material recommends its use. With the wide variation in quality and content of online information, it is important for physicians to be aware of the different platforms and opinions that are readily available to patients.

The Use of eHealth Practices by United States Patients with Self-Reported Glaucoma

PURPOSE

Patient-oriented eHealth practices (e.g., scheduling appointments on the Internet, communicating with providers online) are an integral part of modern healthcare delivery. It is not known what proportion of United States patients with glaucoma use eHealth and how this use compares with those without glaucoma.

DESIGN

Cross-sectional study.

PARTICIPANTS

Participants in the 2016 through 2017 National Health Interview Survey (NHIS), a cross-sectional survey regarding health topics that is administered annually to a nationally representative sample of noninstitutionalized adults in the United States.

METHODS

Based on the NHIS complex survey design, we calculated the proportion of participants with and without glaucoma who used 5 different eHealth practices (looking up health information on the Internet, requesting or ordering a prescription medication on the Internet, scheduling a medical appointment on the Internet, communicating with healthcare provider online, and using online groups to learn about health topics) during the 12 months before the survey. We performed univariate and multivariate logistic regression to evaluate the association between self-reported glaucoma diagnosis and use of the eHealth practices.

MAIN OUTCOME MEASURES

Proportion using eHealth practices and odds ratios (ORs).

RESULTS

Forty thousand four hundred sixty-five survey participants were included in the analysis; 1932 had self-reported glaucoma and 38 533 did not. For those with glaucoma, 46.2% (95% confidence interval [CI], 43.3%-49.0%) used at least one of the eHealth practices in the 12 months before the survey compared with 52.5% (95% CI, 51.5%-53.5%) of those without glaucoma (P < 0.001). After adjusting for confounders, participants with glaucoma were more likely to report use of at least 1 of the eHealth practices compared with those without glaucoma (adjusted OR, 1.22; 95% CI, 1.06-1.40; P = 0.005).

CONCLUSIONS

In this nationally representative United States population, nearly half of people with glaucoma reported using eHealth practices. Although a lower proportion of people with glaucoma used eHealth practices compared with those without glaucoma, this relationship actually reversed after adjusting for confounders. Because many patients with glaucoma are capable of and already using e-Health, further investment in these technologies may be beneficial.

Influence of Cost of Care and Adherence in Glaucoma Management: An Update

The costs for glaucoma care are rising worldwide. The main reason is the increase of life expectancy and the increasing variety of diagnostic tests and therapeutically options by implants and devices. How can we influence the increase in costs? Does a relationship exist between the rising costs and the behavior of patients especially in regard to adherence of patients to the prescribed therapy? Are there ways to improve adherence? The costs of a disease can be estimated by adding the direct costs and the indirect costs deriving from the disease. Many studies have been looking at the direct costs, for example, the costs of diagnostic tests and treatment modalities. Unfortunately, not many studies investigated the indirect costs, i.e., costs related to the need of a person to accompany the patient during his or her outpatient visits or the costs deriving from loss of work capacity because of the disease itself or the outpatient visits. Adherence or the synonym compliance has been discussed since many years, and it seems that it remains a major problem in the management of many chronic diseases. Despite all efforts to improve adherence, the adherence rate in chronic diseases such as glaucoma or arterial hypertension remains considerably low. One of the main factors in improving adherence is raising patient's awareness of the disease by providing general understanding of their disease. Other important factors are simplified therapeutic regimens, e.g., fixed combination drops, sustained drug release techniques, or new glaucoma surgical procedures with a more favorable risk profile.

Investigation of medication adherence and reasons for poor adherence in patients on long-term glaucoma treatment regimes

PURPOSE

Long-term treatment adherence for a chronic asymptomatic condition is a demanding task for many patients. Treating progressive glaucoma can also be confounding for physicians, particularly when management relies on assumption of adherence. This study investigated associations between self-reported adherence and frequency of medication changes due to glaucoma progression.

METHODS

A total of 128 participants with primary open angle glaucoma were recruited from glaucoma clinics in Flinders Eye Center, South Australia, and completed confidential questionnaires. Information was obtained regarding beliefs about glaucoma and their treatment. Adherence was assessed using the four-item Morisky, Green and Levine Medication Adherence Questionnaire (MGL). Medical records were analyzed for the number of medication changes, due to glaucoma progression.

RESULTS

Adherence to topical glaucoma medication was categorized as 'high' in 41.4% (Morisky, Green and Levine (MGL). Data were analyzed for behaviors affecting adherence, history of adherence, and reasons for changed adherence. Chi-squared test demonstrated that there was no significant association noted between adherence and changes in medication regime (χ² (2,128)=0.968, P=0.915); however, a significantly lower adherence was detected if participants had difficulties with their drop regime (χ² (2,128)=7.24, P=0.027) or had help with drop insertion (χ² (1,128)=9.77, P=0.008).

CONCLUSION

This study revealed a higher rate of non-adherence than has previously been demonstrated in other studies. This may be attributed to the unique design of the confidential questionnaire and the independent and sympathetic questioning techniques used. Further work to develop a specific glaucoma medication adherence questionnaire would be valuable to enhance glaucoma management.