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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, Volume: 104, Issue: 12, Pages: 1704 - 1709

Swansea University Authors: Simon Read, Pippa Anderson

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Abstract

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...

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Published in: British Journal of Ophthalmology
ISSN: 0007-1161 1468-2079
Published: BMJ 2020
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URI: https://cronfa.swan.ac.uk/Record/cronfa53505
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spelling 2021-09-08T13:09:15.6952993 v2 53505 2020-02-11 Acceptability, adherence and economic analyses of a new clinical pathway for the identification of non-responders to glaucoma eye drops: a prospective observational study a5fdd0f9bc9dd4b6716fc42cb1ee8a30 Simon Read Simon Read true false 128cdedfba6e5e6374fdc85d5c78c428 Pippa Anderson Pippa Anderson true false 2020-02-11 PHAC 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. Journal Article British Journal of Ophthalmology 104 12 1704 1709 BMJ 0007-1161 1468-2079 23 11 2020 2020-11-23 10.1136/bjophthalmol-2019-315436 Accepted Post-Print version available at http://orca.cf.ac.uk/130190/ COLLEGE NANME Public Health COLLEGE CODE PHAC Swansea University 2021-09-08T13:09:15.6952993 2020-02-11T16:45:02.2575179 College of Human and Health Sciences Swansea Centre for Health Economics Heather Waterman 1 Simon Read 2 James Edwards Morgan 3 David Gillespie 4 Claire Nollett 5 Davina Allen 6 Marjorie Weiss 7 Pippa Anderson 8
title Acceptability, adherence and economic analyses of a new clinical pathway for the identification of non-responders to glaucoma eye drops: a prospective observational study
spellingShingle Acceptability, adherence and economic analyses of a new clinical pathway for the identification of non-responders to glaucoma eye drops: a prospective observational study
Simon Read
Pippa Anderson
title_short Acceptability, adherence and economic analyses of a new clinical pathway for the identification of non-responders to glaucoma eye drops: a prospective observational study
title_full Acceptability, adherence and economic analyses of a new clinical pathway for the identification of non-responders to glaucoma eye drops: a prospective observational study
title_fullStr Acceptability, adherence and economic analyses of a new clinical pathway for the identification of non-responders to glaucoma eye drops: a prospective observational study
title_full_unstemmed Acceptability, adherence and economic analyses of a new clinical pathway for the identification of non-responders to glaucoma eye drops: a prospective observational study
title_sort Acceptability, adherence and economic analyses of a new clinical pathway for the identification of non-responders to glaucoma eye drops: a prospective observational study
author_id_str_mv a5fdd0f9bc9dd4b6716fc42cb1ee8a30
128cdedfba6e5e6374fdc85d5c78c428
author_id_fullname_str_mv a5fdd0f9bc9dd4b6716fc42cb1ee8a30_***_Simon Read
128cdedfba6e5e6374fdc85d5c78c428_***_Pippa Anderson
author Simon Read
Pippa Anderson
author2 Heather Waterman
Simon Read
James Edwards Morgan
David Gillespie
Claire Nollett
Davina Allen
Marjorie Weiss
Pippa Anderson
format Journal article
container_title British Journal of Ophthalmology
container_volume 104
container_issue 12
container_start_page 1704
publishDate 2020
institution Swansea University
issn 0007-1161
1468-2079
doi_str_mv 10.1136/bjophthalmol-2019-315436
publisher BMJ
college_str College of Human and Health Sciences
hierarchytype
hierarchy_top_id collegeofhumanandhealthsciences
hierarchy_top_title College of Human and Health Sciences
hierarchy_parent_id collegeofhumanandhealthsciences
hierarchy_parent_title College of Human and Health Sciences
department_str Swansea Centre for Health Economics{{{_:::_}}}College of Human and Health Sciences{{{_:::_}}}Swansea Centre for Health Economics
document_store_str 0
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description 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.
published_date 2020-11-23T04:07:45Z
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