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In order to improve patient education, compliance, and administration of eye drops prescribed for patients suffering with glaucoma within a UK ophthalmology department, an eye drop chart (EDC) was designed, developed, and piloted with patients attending the glaucoma clinic over 1 month.
A cross-sectional prospective pilot study of 25 patients using...
Citations
... Unintentional non-adherence is caused by external factors (economic burden, physical limitations, or forgetfulness) and incorrect drug administration. Inappropriate eyedrop instillation is unintentional non-adherence but can improve with education, as explored in several previous studies [6][7][8][9][10]. Patients were either directly instructed by clinicians or given handouts or videos. ...
Background
To evaluate the effectiveness of instillation technique education using self-video feedback in glaucoma patients.
Methods
Sixty-two patients who self-instilled glaucoma eyedrops were randomly assigned to the self-video feedback and control groups according to the block randomization. Each group of the patient was asked to instill eyedrops, and videos were recorded. For the control group, only an educational video was provided. In the self-video feedback group, the patients provided educational video and feedback using a recorded video of their own instillation. After 1 month of education, the patient's instillation techniques were video-recorded again. We divided the steps of instilling eyedrops into ten steps and evaluated whether each step was properly performed using the recorded images from each patient. The main outcome was the proportion of patients who properly instilled their eyedrops in each step.
Results
Before education, there was no significant difference in the proportion of patients who were properly instilled between the two groups. In the group that received video feedback, the proportion of patients who instilled the eyedrops correctly after education in some items was significantly higher than that of the control group, and in particular, the educational effect of 'avoids touching dropper to eyelid or eyelash' was superior.
Conclusions
In patients with glaucoma, education on the method of instillation was effective in improving the techniques of instillation. In the items that required accurate actions, the video feedback that allowed the patient to observe themselves had a better improvement effect compared to the traditional education method.
Trial registration number
KCT0008090 (09/01/2023, retrospectively registered).
... People between 40 and 80 years old are at a higher risk of developing glaucoma [6, 9,10]. More men in this study were affected, contrary to ndings by Katherine and Georgios [11] but supporting the ndings by Kristianslund et al. [12] for Open Angle Glaucoma. Although most were employed [Artisan (4.84%), Civil servant (35.48%), ...
... Adherence was low among most respondents (59.68%), like the report by Gupta et al. [8], but departed from the ndings by McVeigh and Vakros [11] among glaucoma patients in Nigeria. Scheduling patients for regular review and re ll of their medications was a signi cant contributor in the latter study and concordance with this study [4]. ...
Background
Glaucoma describes a group of ocular disorders with multi-factorial aetiology characterised by raised intraocular pressure and associated optic neuropathy. Globally, it is the leading cause of irreversible blindness. Several studies on clients’ adherence to medications have shown that many clients do not adhere to medication regimens, and this is a significant factor leading to the various complications of the disease. This study determined the factors that influenced the adherence of glaucoma patients to topical eye drops in Ho Teaching Hospital (HTH).
Methods
This cross-sectional study involved glaucoma patients aged 18 years and above on topical eye drops who attended the eye clinic of HTH. The questionnaires administered obtained data from the patients and exported to STATA version 16 for cleaning and analysis at a significant level of 0.05.
Results
More than half (59.7%), 25.8% (32) and only 14.5% (18) showed low, moderate, and high adherence, respectively. There was a significant association between clients’ response to glaucoma leading to blindness, glaucoma treatment preventing complications and adherence (χ2 = 6.25, p = 0.044) and (χ2 = 6.26, p = 0.044), respectively. The length of glaucoma medication usage (χ = 25.29, p = 0.001), number of drugs (χ 2 = 15.25, p = 0.002), distance from the place of residence to the hospital (x2 = 10.02, p = 0.007), coming for regular review (x2 = 33.81, p = < 0.001) and number of times medication is applied to the eye per day (χ 2 = 15.95, p = 0.001) were statistically associated to adherence to glaucoma medication.
Conclusion
The level of adherence to medication among respondents was low. Factors influencing medication adherence included proximity to the health facility and reporting for regular reviews. Having glaucoma, being on medication over a more extended period and providing further clarification on the drug regimen influenced the adherence rate among respondents. We recommend that health workers offer detailed and clear instructions on instilling medication to improve glaucoma medication adherence.
... The study revealed that more than half of the patients washed their hands before administering eye drops. This result is in accordance with other studies [33], whereas other studies reported lesser numbers showing this behavior [18,34]. Moreover, the results showed that the majority of patients had the correct position of the head during the administration, and less than half (44%) of the patients pulled down the lower eyelid to form a pocket. ...
Background: Drug therapy problems are the main obstacle in the management of chronic diseases. Improper use of medications and non-adherence to medication use are regarded as major factors halting the management of glaucoma. Aim: The present study was designed to shed light on the problems associated with medication therapy for patients with glaucoma in Sulaimani City. Method: A cross-sectional study was conducted on fifty patients with glaucoma. Questionnaires were used for demographic data, the patient’s quality of life, and adherence. Patients were assessed for dry eye by using Schirmer’s test type 1. Drug therapy problems (DTPs) and drug interactions were checked using the Medscape interaction database. Results: 60% of the patients were washing their hands before administering eye drops. The majority of patients had the correct position of the head during the administration. While 60% of the patients were closing their eyes after the administration for 2 or 3 minutes. Regarding adherence, only 24% of patients were perfectly adherent to medication use. Noncompliance with their treatments and adverse drug reactions were the most commonly observed DTPs. Thirty-seven of the patients had a metallic taste, and the most common type of drug interactions were significant interactions. Conclusion: The absence of pharmaceutical care has led to many problems associated with the improper use of antiglaucoma drugs. Pharmacists may play a pivotal role in improving the outcomes of patients with glaucoma.
... The study revealed that more than half of the patients washed their hands before administering eye drops. This result is in accordance with other studies [33], whereas other studies reported lesser numbers showing this behavior [18,34]. Moreover, the results showed that the majority of patients had the correct position of the head during the administration, and less than half (44%) of the patients pulled down the lower eyelid to form a pocket. ...
Background: Drug therapy problems are the main obstacle in the management of chronic diseases. Improper use of medications and non-adherence to medication use are regarded as major factors halting the management of glaucoma. Aim: The present study was designed to shed light on the problems associated with medication therapy for patients with glaucoma in Sulaimani City. Method: A cross-sectional study was conducted on fifty patients with glaucoma. Questionnaires were used for demographic data, the patient's quality of life, and adherence. Patients were assessed for dry eye by using Schirmer's test type 1. Drug therapy problems (DTPs) and drug interactions were checked using the Medscape interaction database. Results: 60% of the patients were washing their hands before administering eye drops. The majority of patients had the correct position of the head during the administration. While 60% of the patients were closing their eyes after the administration for 2 or 3 minutes. Regarding adherence, only 24% of patients were perfectly adherent to medication use. Noncompliance with their treatments and adverse drug reactions were the most commonly observed DTPs. Thirty-seven of the patients had a metallic taste, and the most common type of drug interactions were significant interactions. Conclusion: The absence of pharmaceutical care has led to many problems associated with the improper use of antiglaucoma drugs. Pharmacists may play a pivotal role in improving the outcomes of patients with glaucoma.
... A memory aid tested in 1991 (C Cap, Allergan) seemed useful (patient requested more refills after receiving the aid) [64]. A 2015 study evaluated an audiovisual reminder system (Eye Drop Chart), but the results reported no significant difference in adherence before and after using the aid [65]. Other tested reminder systems are alarm devices [66,67], while telephone calls and SMS have been tested solely as clinical appointment reminders [68]. ...
Glaucoma is a group of progressive optic neuropathies characterized by loss of retinal ganglion cells and visual field deterioration. Despite the fact that the underlying pathophysiology of glaucoma remains unknown, elevated intraocular pressure (IOP) is a well-established risk factor, and the only factor that can be modified. Robust evidence from epidemiological studies and clinical trials has clearly demonstrated the benefits of IOP control in reducing the risk of glaucoma progression. IOP-lowering therapy by the means of eye drops remains a first-line treatment option. However, like other chronic and asymptomatic conditions, many patients with glaucoma have difficulties in maintaining high rates of adherence persistence to prescribed medications. On average, patients with chronic medical conditions take 30-70% of the prescribed medication doses, and on average 50% discontinue medications in the first months of therapy. The ophthalmic literature shows similarly low rates of adherence to treatment. Indeed, poor adherence is associated with disease progression and increased complication rates, as well as healthcare costs. The present review analyzes and discusses the causes of variability of the adherence to the prescribed drugs. The education of patients about glaucoma and the potential consequences of insufficient adherence and persistence seems fundamental to maximize the probability of treatment success and therefore prevent visual disability to avoid unnecessary healthcare costs.
... Topical anti-glaucoma medications are used for a long period of time and require longterm adherence to achieve a maximum IOP lowering effect [6,7]. Adherence to topical antiglaucoma medications can considerably slow disease progression and visual disability at a lower cost [8,9]. ...
Purpose:
To assess the proportion of adherence to topical anti-glaucoma medications and associated factors among glaucoma patients in Sidama regional state, Ethiopia.
Methods:
An institution based cross-sectional study was conducted from May 30 to July 15, 2022 at Hawassa University comprehensive specialized and Yirgalem General Hospitals in Sidama regional state, Ethiopia. A systematic random sampling method was used to select 410 study participants. An adapted eight-item self-reported questionnaire was used to assess adherence. Binary logistic regression was used to identify factors associated with adherence to topical anti-glaucoma medications. Variables with a p-value of <0.05 under multivariable analysis were taken as statistically significant factors for adherence. The strength of the association was measured by using an adjusted odds ratio with 95% confidence interval.
Results:
A total of 410 participants were included giving a response rate of 98.3%. Those who were adherent to their medications were 221(53.9%) (95% CI: 48.8-58.5). Urban residence (AOR = 2.81: 95% CI = 1.34-5.87), higher educational level (AOR = 3.17: 95% CI = 1.24-8.09), monthly follow-up frequency (AOR = 3.30: 95% CI = 1.79-6.11) and normal vision (AOR = 6.58: 95% CI = 3.03-10.84) were significantly associated with adherence.
Conclusion:
More than half of glaucoma patients attending at Hawassa University comprehensive specialized and Yirgalem general hospitals were adherent to their topical anti-glaucoma medications. Urban residence, educational level, follow-up frequency, and normal vision were associated with adherence.
... Still, only 64% suggested the EDC method was valid, and 88% recommended it to their friend. [13] Several studies reveal that 15-52% of the patients touched the tip of the ED bottle while applying the drops. [12][13][14] In another study conducted on 247 patients on the knowledge and practice of multiple ED usage among glaucoma patients, only 4.9% washed their hands before instillation, only 13.4% had adequate knowledge, and 2% showed good practice. ...
... [13] Several studies reveal that 15-52% of the patients touched the tip of the ED bottle while applying the drops. [12][13][14] In another study conducted on 247 patients on the knowledge and practice of multiple ED usage among glaucoma patients, only 4.9% washed their hands before instillation, only 13.4% had adequate knowledge, and 2% showed good practice. [1,2] Hence, improving patient education would be the simplest and most cost-effective way to increase compliance and clinical outcomes. ...
Purpose: The purpose of this study is to study the patient's awareness of the proper method of eye drop (ED) opening and usage among patients attending the outpatient and specialty clinics of a tertiary eye care center in South India. Methods: A questionnaire-based cross-sectional survey was conducted among 514 patients attending outpatient departments of general units and specialty clinics by seven study coordinators. The questionnaire consists of 10 simple questions to assess the awareness of these patients on ED opening, usage methods, and from whom they received the information. Immediately, at the end of the questionnaire, all the patients participating in the survey were properly instructed on the right method of ED usage. In addition, they were inquired about the right mode of communication on the topic of interest. Results: Total number of participants included was 514. Mean age was (standard deviation) 50.58 (20.8) years; only 3.3% (17) were not informed about the proper usage of ED method by any of the staff or the counselors or doctors from the hospital, and 96.7% (497) were counseled for the proper method of ED usage. Among them, the information was properly explained to 82.7% (412) of the respondents by the counselors in each department; only 7.4% (37) were explained by the doctors. Most of them, 80.2% (412), preferred direct oral conversation methods of counseling on ED usage, 9.9% (51) preferred through posters, 7% (36) through video displays, and only 9% (10) through public address systems. Conclusion: A separate, precise ED counseling system is necessary for delivering proper instructions on ED usage and opening. The patient's education with eye-to-eye contact from the counselors is the patient's preferred route of obtaining information on ED usage.
... Community pharmacists must therefore have adequate knowledge about ophthalmic preparations to optimize therapeutic 7 outcomes. Inappropriate administration technique is a major cause of therapeutic failure in patients on long-term use of 8 ophthalmic preparations. Lampert and colleagues (2019) stressed the importance of reiterating the administration 9 technique during refills to reinforce patient adherence. ...
Background: The ratio of patients to ophthalmologists is rather high, affording inadequate time for patient interaction, especially on the use of ophthalmic preparations. An assessment of community pharmacists' knowledge and counselling on ophthalmic preparations is vital to maintaining quality of care received by patients. Methods: A cross-sectional study was carried out among consented community pharmacists practicing in Ibadan metropolis in southwest Nigeria, who were randomized into control and intervention arms. Baseline assessment of their knowledge and counselling on ophthalmic preparations was done. An educational intervention was then carried out among the intervention pharmacists. Postintervention assessment was carried out to evaluate the effect of the intervention. Data was summarized with descriptive and inferential statistics. Results: A total of 115 (control arm-62; intervention arm-53) community pharmacists participated in the study. Percentage of community pharmacists who understood punctal occlusion (control vs intervention) increased from 21.0% vs 22.6% at baseline to 45.4% vs 83.0% postintervention. Preintervention (control vs intervention), 83.9% vs 81.1% knew that eye drop bottle tip should not touch the eyes during application. This improved postintervention to 82.3% vs 100%. A significant difference in participants' knowledge and counselling on ophthalmic preparations was observed postintervention. Participants' knowledge comparison (control vs intervention) was 7.79 ± 1.79 vs 7.60 ± 1.65 (p = 0.565) and 8.89 ± 1.73 vs 10.83 ± 1.63 (p < 0.001) at baseline and postintervention, respectively. The counselling comparison (control vs intervention) was 2.82 ± 1.93 vs 2.57 ± 1.91 (p = 0.476) at baseline, and 2.97 ± 2.48 vs 5.98 ± 1.69 (p < 0.001) postintervention. Conclusion: The educational intervention, which addressed the knowledge and counselling gaps discovered at baseline, improved the community pharmacists' knowledge and counselling on ophthalmic preparations.
... [10,17] Verbal counselling can also be complemented by providing patients with an additional instructional leaflet and a medication chart detailing the types and frequency of each eye drop, which were found to be useful in improving instillation technique and adherence. [19] More labour-intensive methods trialled elsewhere with encouraging results include providing patients feedback based on their videotaped performance and using the motivational interviewing approach. [20,21] Multimodal approach may be effective in ensuring good instillation technique, but the key to long-term technique retention is likely to be constant reinforcement and reassessment. ...
Objectives
This study aimed to explore the eye drop instillation technique of patients with glaucoma and whether a pharmacist-led counselling session can improve their technique. Patients’ perceptions of pharmacists’ role in providing the counselling were also explored.
Methods
This cross-sectional study was conducted between December 2020 and March 2021 at Sarawak General Hospital, Malaysia. Convenience sampling was used to recruit patients with glaucoma who self-administered their eye drops. Participants’ background information were obtained using an investigator-administered questionnaire before their eye drop instillation technique was assessed. Those with imperfect techniques were counselled by a pharmacist before being reassessed. Differences in eye drop instillation competency were determined using paired T-test.
Key findings
A total of 138 participants were recruited. Participants were on a median of two eye drops (IQR 2-4) for a median of five years (IQR 2-8). Prior to being counselled, they demonstrated a mean total of 8.4/13 steps (SD 2.33) correctly. A statistically significant improvement in eye drop instillation technique was observed post-pharmacists’ counselling, with a mean increase of 4.3 steps demonstrated correctly (95% CI, 4.0 to 4.7, P < 0.001). The majority of participants agreed that pharmacists are knowledgeable in providing counselling on eye drop administration techniques.
Conclusions
Patients with glaucoma treated at Sarawak General Hospital had imperfect eye drop instillation techniques, despite most having used their eye drops for several years. Interventions by pharmacists to improve eye drop instillation are crucial to optimise the medical treatment of patients with glaucoma.
... Wyniki badań przedstawionych w piśmiennictwie są niepokojące. Najczęściej popełniane przez pacjentów błędy to zaniedbywanie mycia rąk przed podaniem, dotykanie końcówki zakraplacza, nieprzestrzeganie okresu przydatności po pierwszym otwarciu czy niepoprawne podanie kropli [1,2]. Tego rodzaju błędy mogą być przyczyną zmniejszenia lub zaniku skuteczności działania leku, a także wtórnego zainfekowania, na skutek nieodpowiedniego sposobu aplikacji leku. ...
Modern packaging provides the preparation of eye drops without the addition of preservatives while maintaining the drug's shelf life. Therefore, various types of structural and functional solutions are used to protect the content against microbial contamination. Multi-dose packages contain multi-stage security mechanisms such as valves, membranes, filters and pressure compensation systems, ensuring the sterility of the preparation. In pharmaceutical practice, it is possible to make a compounded eye drops without preservatives in single-dose containers, the so-called minims, multi-dose plastic mini-bottles or, more recently, in multi-dose containers preventing contamination of the drug during the period of its use by the patient. The period after opening varies according to the type of container. The minims are intended for single use only. The preparation closed in a mini-bottle can be used several times, up to a maximum of 24 hours. However, in the case of multiple dose Novelia® packs of various capacities, the preparation can be used for 4 weeks.
The results of sterility tests of two compounded eye drops, carried out by the direct inoculation method, confirmed the effectiveness of packaging protection with the preservative-free dispenser and the possibility of denoting the use-by period of 4 weeks. These packages are available with three types of applicators adapted to different viscosity eye drops, which is advantageous in the context of ensuring adequate dosing accuracy but requires knowledge and sensible choice of the correct package by the person who prepares the drops. A comparison of preservative-free packages for compounded eye drops was also carried out in terms of the consumption of the polymer necessary for their production and the possibility of using the drug contained in them. The new multi-dose containers for compounded eye drops are a good complement to the range of eye drops packaging, due to the sterility of the preparation during therapy, easy application and economical use of the drug and packaging material.
