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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 / Heather Waterman; Simon Read; James Edwards Morgan; David Gillespie; Claire Nollett; Davina Allen; Marjorie Weiss; Pippa Anderson
British Journal of Ophthalmology, Pages: bjophthalmol - 2019
Swansea University Author: Pippa, Anderson
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Aim: To assess whether a new clinical pathway for glaucoma, the Cardiff Model of Glaucoma Care (CMCG) 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...
|Published in:||British Journal of Ophthalmology|
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Aim: To assess whether a new clinical pathway for glaucoma, the Cardiff Model of Glaucoma Care (CMCG) 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 undertaken with patients and healthcare professionals. To determine clinical responsiveness, intraocular pressures were measured before and four-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 1,376 drop instillation days under observation, eye-drops were instilled as prescribed on 1,004 days (73.0%), over-instilled on 137 days (9.9%) and not instilled on 235 days (17.1%). The CMCG involved negligible cost, although acceptance for healthcare professionals showed variation. Conclusions: CMCG offers novel clinical and adherence insights at marginal costs while acceptable to patients. Healthcare professionals felt that four-hour and four- week follow-up appointments could cause administrative problems. A streamlined version of the pathway has therefore been developed to facilitate clinical adoption.