UK Society for Behavioural Medicine 9 th Annual Scientific Meeting

Transcription

1 UK Society for Behavioural Medicine 9 th Annual Scientific Meeting Behavioural Medicine: From Laboratory to Policy University of Oxford Examination Schools Monday 9 and Tuesday 10 December 2013 NPRI

2 UK Society for Behavioural Medicine 9 th Annual Scientific Meeting Behavioural Medicine: From Laboratory to Policy NPRI Parallel Session D Health professional and education, and family and social determinants Chaired by Ronan O Caroll

3 UK Society for Behavioural Medicine 9 th Annual Scientific Meeting Behavioural Medicine: From Laboratory to Policy User experiences of a behaviour change intervention study to improve adherence to glaucoma medication Heidi Cate NPRI

4 Improving adherence to glaucoma medication: User experiences of a behaviour change intervention Heidi Cate BSc, MSc Debi Bhattacharya, David C Broadway

5 Introduction Non-adherence to glaucoma medication: Visual field loss Complex dosing regimens Additional hospital appointments Inappropriate surgical risks Increases cost of care: Additional prescribing Wastage of eye drops Surgical treatment

6 Introduction A previous qualitative study identified the gateways required for good long-term adherence Diagnosis Initial education Motivation Correct application Remember Practical problems Long-term adherence Further reading: Lacey J, Cate H, Broadway DC. Adherence with glaucoma medication a qualitative study. Eye (Lond) 2009;23:

7 The Education Intervention Behaviour Change Counselling (BCC) to assess ambivalence and improve motivation to eye drop use (Rollnick S. et al. 2002) Provide information about: glaucoma medication correct drop application techniques Discuss routine for daily use of eye drops Diagnosis Initial education Motivation Correct application Remember Practical problems Long-term adherence

8 Method Patients newly prescribed travoprost Demonstration of Travalert Dosing Aid (TDA) Randomisation Control Group Standard Care Intervention Group Standard Care and Education Intervention with Telephone Helpline 8 Months monitoring with TDA

9 Method Patients Travalert newly Dosing prescribed Aid (TDA): travoprost A computerised bottle holder that Demonstration records the dosing of Travalert times Dosing of eye Aid drops. (TDA) Randomisation Control Group Standard Care Intervention Group Standard Care and Education Intervention with Telephone Helpline 8 Months monitoring with TDA

10 Method Patients newly prescribed travoprost Demonstration of Travalert Dosing Aid (TDA) Randomisation Control Group Standard Care Intervention Group Standard Care and Education Intervention with Telephone Helpline 8 Months monitoring with TDA

11 Aim Explore the user experiences of the Norwich Adherence Glaucoma Study (NAGS) study with respect to study conduct and the impact of the intervention used in the study.

12 Method NAGS Study Randomised 208 participants Final 30 participants completed were invited to attend a focus group Convenience sampling used to select 20 participants Glaucoma Support Assistants invited to attend a separate focus group Transcripts were transcribed verbatim and analysed using Framework Theory Approach. (Ritchies & Spencer 1994)

13 Participant recruitment 16 participants confirmed to attend a focus group meeting (8 participants in each group) 3 participants were unable to attend on the day of the Group 2 meeting Total n=13 Group 1 n=8 Group 2 n=5 Male No. (%) Yes 8 (62) 4 (50) 4 (80) Control arm No. (%) Yes 7 (54) 6 (75) 1 (20) 4 GSAs confirmed to attend the GSA meeting, but one was unable to attend on the day

14 Results

15 Results Comparison of Control / Intervention Groups Study participation Wider issues affecting glaucoma patients User experiences Hawthorn effects? Glaucoma Support Assistant s Patient experiences of Eye Clinic

16 Results 1. Study participation improved perceived quality of care and the control group had more dedicated face-to-face time with a caregiver. CG I felt that the GSA was very good, took us to one side and explained the whole thing. I think I was the last one to leave the clinic but she still had time for me. CG I would agree GSA And we tried with the control patients not to bring them into our room because we were then almost inviting them to ask us questions and talk more

17 Results 2. The informed consent process increased awareness of the study objectives and need to use eye drops CG That we have had this information reinforces us to take the drops. CG Because you know we have had more information than you know perhaps a lot of people would have had and it is probably good for the longer term.

18 Results 3. Use of TDA was a reminder to use drops and that adherence was being monitored. CG Because it was like there, in a box big enough, it just reminded you to do it so I just found it easier because it was visible really. CG Yes, I mean I joked about it being like Big Brother, keeping an eye on what I was doing IG I ve kept daily record in fact of both the times, the number of drops and what I ve used

19 Results 4. Use of TDA helped to administer eye drops CG I find it really helped, that gadget with the bottle because you just click it down once and it just gives a drop out. CG I would second that. IG Yeah, I do.

20 Results 5. Completion of questionnaires raised awareness of information not previously discussed with the control group Because the control group were given GSA questionnaires which prompted them probably to think of things that they perhaps wouldn t have thought about because they re reading these questions GSA That s probably one thing that came up most as a query on the questionnaires and probably quite a few of our phone calls were concerning around whether they should call the DVLA with regards to driving

21 Discussion

22 Discussion This may have contributed to the absence of a demonstrable difference between the two groups Measuring adherence in glaucoma patients is problematic and a gold-standard is yet to be defined

23 Conclusion Hawthorne effects may be of greater significance than is currently recognised in adherence intervention study designs Modified consent procedures including retrospective consent may be an appropriate solution

24 References Lacey J, Cate H, Broadway D C. Barriers to adherence with glaucoma medications: a qualitative research study. Eye (Lond) 2009;23(4): Rollnick S, Allison J, Ballasiotes S, et al. Variations on a Theme: Motivational Interviewing and Its Adaptations. In: Miller WR, Rollnick S, eds. Motivational Interviewing: Preparing People for Change. New York: Guildford Press, 2002 Ritchie J, Spencer L. Qualitative data analysis for applied policy research. In: Bryman A, Burgess R, editors. Analysing Qualitative Data. London: Routledge; p

25 Acknowledgements Participants from the Norfolk & Norwich Eye Department Michael Twigg and Claire Easthall from the University of East Anglia - Moderation of the Focus Groups Intellectual Property Statement This presentation presents independent research commissioned by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG ). The views expressed are those of the authors and not necessarily those of the NHS, NIHR or the Department of Heath.

26 Additional info Despite use of rigorous research methods, participants demonstrated higher adherence rates than anticipated with no statistically significant difference

27 NPRI UK Society for Behavioural Medicine 9 th Annual Scientific Meeting Behavioural Medicine: From Laboratory to Policy