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Acceptability, adherence and economic analyses of a new clinical pathway for the identification of non-responders to glaucoma eye drops: a prospective observational study

Waterman, Heather, Read, Simon, Morgan, James Edwards, Gillespie, David, Nollett, Claire, Allen, Davina, Weiss, Marjorie and Anderson, Pippa 2020. Acceptability, adherence and economic analyses of a new clinical pathway for the identification of non-responders to glaucoma eye drops: a prospective observational study. British Journal of Ophthalmology 104 (12) , pp. 1704-1709. 10.1136/bjophthalmol-2019-315436

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Abstract

Background/aims Assess whether a new clinical pathway for glaucoma was acceptable to patients and healthcare professionals and whether it provided useful clinical information on non-responsiveness and non-adherence to the treatment of elevated intraocular pressure with latanoprost eye drops. Methods A single arm non-randomised prospective observational study incorporating new glaucoma/ocular hypertension patients. To assess issues of acceptability, qualitative observation and interviews were conducted with patients and healthcare professionals. To determine clinical responsiveness, intraocular pressures were measured before and 4 hours after a clinician-instilled eye drop over two distinct appointments. Adherence data were collected using a Medicine Event Monitoring System. Economic analyses compared the costs between novel and standard care pathways. Results Of 72 patients approached, 53 entered the study (74.3%) and 50 completed all procedures (94.3%). Intraocular pressure was reduced more than 15% in 83 out of 92 study eyes by final visit (90.2%). The non-response rate was 5.1% once the effect of low adherence was minimised. For the 1376 drop instillation days under observation, eye drops were instilled as prescribed on 1004 days (73.0%), over-instilled on 137 days (9.9%) and not instilled on 235 days (17.1%). The Cardiff Model of Glaucoma Care involved negligible cost, although acceptance for healthcare professionals showed variation. Conclusions The Cardiff Model of Glaucoma Care offers novel clinical and adherence insights at marginal costs while acceptable to patients. Healthcare professionals felt that 4 hour and 4 week follow-up appointments could cause administrative problems. A streamlined version of the pathway has therefore been developed to facilitate clinical adoption. Trial registration number ISRCTNID:ISRCTN75888393

Item Type: Article
Date Type: Publication
Status: Published
Schools: Pharmacy
Optometry and Vision Sciences
Healthcare Sciences
Centre for Trials Research (CNTRR)
Subjects: H Social Sciences > H Social Sciences (General)
R Medicine > RE Ophthalmology
R Medicine > RM Therapeutics. Pharmacology
R Medicine > RT Nursing
Publisher: BMJ Publishing Group
ISSN: 0007-1161
Funders: Health and Care Research Wales
Related URLs:
Date of First Compliant Deposit: 12 March 2020
Date of Acceptance: 30 January 2020
Last Modified: 24 Nov 2020 21:59
URI: http://orca.cf.ac.uk/id/eprint/130190

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