A structured, motivational interviewing–based coaching program significantly improved medication adherence and reduced glaucoma-related distress compared with standard written education, according to a randomized clinical trial published in JAMA Ophthalmology.
The Support, Educate, Empower (SEE) trial enrolled 235 adults with glaucoma from the University of Michigan and Henry Ford Health System who self-reported poor adherence to at least one ocular hypotensive medication. Participants were randomized 1:1 to the SEE intervention (n = 117) or to enhanced usual care consisting of three mailings of standard written glaucoma education (n = 118).
The six-month SEE program combined three in-person sessions and four between-visit phone calls with a trained, nonphysician glaucoma coach. The intervention incorporated personalized multimedia education, motivational interviewing–based counseling, automated medication reminders, and real-time feedback from electronic adherence monitoring. Adherence was measured using electronic bottle monitors and calculated as the percentage of prescribed doses taken on time over six months, with an adherent event being defined as use of an eye drop within a specified time window.
At baseline, mean self-reported adherence was 63.9%. By study end, electronically monitored adherence was significantly higher in the SEE group compared with controls (mean 77.6% vs 58.0%). More than half of SEE participants (54.9%) achieved at least 80% adherence, compared with 23.7% of controls. The improvement exceeded the prespecified minimally important clinical difference for glaucoma medication adherence.
Importantly, the effect persisted across multiple sensitivity analyses, including worst-case and best-case assumptions regarding missing data.
Beyond adherence, the intervention was associated with a meaningful reduction in glaucoma-related distress. Participants in the SEE arm experienced a greater decline in composite distress scores compared with controls. Reductions were driven largely by improvements in emotional burden and regimen-related distress. While SEE participants shifted from moderate to little or no distress over six months, control participants remained in the moderate range.
The study builds on prior evidence suggesting that multifaceted, personalized adherence interventions are more effective than single-component strategies. Unlike earlier programs that relied heavily on clinician expertise, the SEE platform incorporates a web-based system capable of generating highly tailored educational content and structured coaching scripts, enhancing scalability.
Overall, the findings suggest that personalized, motivational interviewing–based coaching can meaningfully improve glaucoma medication adherence and reduce disease-related distress. The investigators now plan to evaluate the SEE program in a pragmatic implementation trial to assess its impact on longer-term biological and system-level outcomes
Source: JAMA Ophthalmology.
The Support, Educate, Empower (SEE) trial enrolled 235 adults with glaucoma from the University of Michigan and Henry Ford Health System who self-reported poor adherence to at least one ocular hypotensive medication. Participants were randomized 1:1 to the SEE intervention (n = 117) or to enhanced usual care consisting of three mailings of standard written glaucoma education (n = 118).
The six-month SEE program combined three in-person sessions and four between-visit phone calls with a trained, nonphysician glaucoma coach. The intervention incorporated personalized multimedia education, motivational interviewing–based counseling, automated medication reminders, and real-time feedback from electronic adherence monitoring. Adherence was measured using electronic bottle monitors and calculated as the percentage of prescribed doses taken on time over six months, with an adherent event being defined as use of an eye drop within a specified time window.
At baseline, mean self-reported adherence was 63.9%. By study end, electronically monitored adherence was significantly higher in the SEE group compared with controls (mean 77.6% vs 58.0%). More than half of SEE participants (54.9%) achieved at least 80% adherence, compared with 23.7% of controls. The improvement exceeded the prespecified minimally important clinical difference for glaucoma medication adherence.
Importantly, the effect persisted across multiple sensitivity analyses, including worst-case and best-case assumptions regarding missing data.
Beyond adherence, the intervention was associated with a meaningful reduction in glaucoma-related distress. Participants in the SEE arm experienced a greater decline in composite distress scores compared with controls. Reductions were driven largely by improvements in emotional burden and regimen-related distress. While SEE participants shifted from moderate to little or no distress over six months, control participants remained in the moderate range.
The study builds on prior evidence suggesting that multifaceted, personalized adherence interventions are more effective than single-component strategies. Unlike earlier programs that relied heavily on clinician expertise, the SEE platform incorporates a web-based system capable of generating highly tailored educational content and structured coaching scripts, enhancing scalability.
Overall, the findings suggest that personalized, motivational interviewing–based coaching can meaningfully improve glaucoma medication adherence and reduce disease-related distress. The investigators now plan to evaluate the SEE program in a pragmatic implementation trial to assess its impact on longer-term biological and system-level outcomes
Source: JAMA Ophthalmology.
