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Paula Anne Newmancasey - One of the best experts on this subject based on the ideXlab platform.

  • comparison of Medication adherence assessment tools to identify Glaucoma Medication nonadherence
    Ophthalmology Glaucoma, 2021
    Co-Authors: Juno Cho, Michele Heisler, Paul P Lee, Leslie M Niziol, Ken Resnicow, David C Musch, Paula Anne Newmancasey
    Abstract:

    PURPOSE To assess the accuracy of 5 subjective self-assessment tools (3 adherence measures and 2 psychometric scales) and pharmacy refill data in predicting objective electronically monitored nonadherence. DESIGN Prospective cohort study. PARTICIPANTS Glaucoma patients (> 40 years old, >1 Medication with poor self-reported adherence) were recruited from University of Michigan Kellogg Eye Center for a study assessing the impact of a personalized Glaucoma coaching program on Medication adherence. METHODS Participants completed an initial assessment including 5 self-assessment tools and a 3-month period of electronic monitoring of Glaucoma Medication adherence (AdhereTech); pharmacy refill data were obtained. Electronically monitored adherence was calculated monthly as the percentage of doses taken on time. The median of these adherence rates was designated as baseline adherence. Patients with adherence of ≤80% by electronic monitoring were considered nonadherent. Self-assessment tools were scored, and pharmacy refill data were summarized as the proportion of days covered. Correlation between measures of adherence was estimated with Pearson and Spearman correlation coefficients. Receiver operating characteristic curves, including estimation of area under the curve (AUC), sensitivity, specificity, and accuracy were used to compare measures of adherence with respect to predicting electronically monitored nonadherence. MAIN OUTCOME MEASURES Accuracy of self-reported and pharmacy refill data adherence measures in predicting electronically monitored nonadherence. RESULTS Ninety-five patients completed 3 months of electronic monitoring with a median monthly adherence of 74 (± 21%); 53 patients (56%) were nonadherent. Pharmacy refill data were not correlated significantly with electronically monitored Medication adherence (r = 0.12; P = 0.2). Of all the measures, a single-item adherence question ("Over the past month, what percentage of your drops do you think you took correctly?") showed the largest correlation with median electronically monitored adherence (r = 0.47; P < 0.0001), largest AUC for predicting nonadherence (AUC = 0.76 [95% confidence interval [CI], 0.66-0.87]), best accuracy (71% [95% CI, 61%-82%]), and good sensitivity (84% [95% CI, 73%-96%]). CONCLUSIONS The single-item question was the most accurate in predicting electronically monitored nonadherence among participants with poor self-reported adherence. In clinical practice, where alternatives are too resource intensive, this free single-item screening question can help to identify Glaucoma patients at risk of poor Medication adherence with reasonable accuracy.

  • increased near activities function associated with increased Glaucoma Medication adherence among support educate empower see participants
    Journal of Glaucoma, 2021
    Co-Authors: Juno Cho, Michele Heisler, Leslie M Niziol, Paula Anne Newmancasey
    Abstract:

    Prcis Higher levels of near-vision related quality of life were associated with higher adherence to Glaucoma Medications after adjusting for important confounding variables among participants in the SEE personalized Glaucoma coaching pilot study. Purpose To investigate the association between vision-related quality of life (VRQoL) and Glaucoma Medication adherence. Materials and methods Subjects were recruited for the Support, Educate, Empower (SEE) program, a prospective non-controlled cohort study examining the impact of a personalized coaching program on Glaucoma Medication adherence. Glaucoma patients seen at the University of Michigan over 40 years old, taking ≥1 Glaucoma Medication, and self-reported poor adherence on two validated scales were recruited. Demographic details and VRQoL using the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) were collected. Participants' Medication use for each prescribed Glaucoma Medication was captured electronically using a Medication events monitoring system (Adheretech, New York, NY). The association between VRQoL and Medication adherence was assessed with Pearson's correlation coefficient (r) and linear regression. Results Among the 95 eligible participants 49.5% were female, 55.3% were Caucasian, and mean age (±standard deviation) was 63.8±10.5 years. Mean adherence to Glaucoma Medication was 73.8%±21.0%. Mean NEI VFQ-25 composite score was 81.6±14.5. Better Medication adherence was significantly and positively correlated with better functioning in domains of ocular pain (r=0.20, P=0.048), near activities (r=0.29, P=0.004), and role difficulties (r=0.22, P=0.036). Linear regression models adjusting for known correlates of Medication adherence (age, gender, race, income), showed a 10-unit increase in self-perceived near activities function was associated with a 2.2% increase in Medication adherence (95% confidence interval 1.0%-5.4%; P=0.0056). Conclusion Better self-perceived near activities function was associated with increased Glaucoma Medication adherence.

  • text parsing based identification of patients with poor Glaucoma Medication adherence in the electronic health record
    American Journal of Ophthalmology, 2021
    Co-Authors: Mohammed Sami Hamid, Joshua D Stein, Leslie M Niziol, Autumn N Valicevic, Brianne Brenneman, Paula Anne Newmancasey
    Abstract:

    Purpose To assess the feasibility of automated text parsing screening of physician notes in the electronic health record (EHR) to identify Glaucoma patients with poor Medication compliance. Design Cross-sectional study. Methods An automated EHR extraction identified a cohort of patients at the University of Michigan with a diagnosis of Glaucoma, ≥40 years old, taking ≥1 Glaucoma Medication, and having no cognitive impairment. Self-reported Medication adherence was assessed with 2 validated instruments: the Chang scale and the Morisky Medication adherence scale. In tandem, a text parsing tool that abstracted data from the EHR was used to search for combinations of the following words in patient visit notes: “not,” “non,” “n't,” “no,” or “poor” accompanied by “adherence,” “adherent, “adhering,” “compliance,” “compliant,” or “complying.” The proportion of patients with self-reported poor adherence was compared between the EHR extraction and text parsing identification using a Fisher exact test. Results Among 736 participants, 20.0% (n = 147) self-reported poor adherence and 6.1% (n = 45) had EHR documentation of poor adherence (P Conclusions Text parsing physician notes to identify patients' noncompliance to their Medications identified a larger proportion of patients who then self-reported poor Medication adherence than an automated EHR pull alone but was limited by the small number of patients identified. Optimizing the documentation of Medication adherence would maximize the utility of this automated approach to identify Medication noncompliance.

  • text parsing based identification of patients with poor Glaucoma Medication adherence in the electronic health record
    American Journal of Ophthalmology, 2021
    Co-Authors: Mohammed Sami Hamid, Joshua D Stein, Leslie M Niziol, Autumn N Valicevic, Brianne Brenneman, Paula Anne Newmancasey
    Abstract:

    PURPOSE To assess the feasibility of automated text parsing screening of physician notes in the electronic health record (EHR) to identify Glaucoma patients with poor Medication compliance. DESIGN Cross-sectional study. METHODS An automated EHR extraction identified a cohort of patients at the University of Michigan with a diagnosis of Glaucoma, ≥40 years old, taking ≥1 Glaucoma Medication, and having no cognitive impairment. Self-reported Medication adherence was assessed with 2 validated instruments: the Chang scale and the Morisky Medication adherence scale. In tandem, a text parsing tool that abstracted data from the EHR was used to search for combinations of the following words in patient visit notes: "not," "non," "n't," "no," or "poor" accompanied by "adherence," "adherent, "adhering," "compliance," "compliant," or "complying." The proportion of patients with self-reported poor adherence was compared between the EHR extraction and text parsing identification using a Fisher exact test. RESULTS Among 736 participants, 20.0% (n = 147) self-reported poor adherence and 6.1% (n = 45) had EHR documentation of poor adherence (P < .0001). Using text parsing as a pre-screening tool, 22 of the 45 patients (48.9%) with non-adherence identified by text parsing also self-reported poor Medication adherence compared to the 20.0% by self-report overall (P < .0001). CONCLUSIONS Text parsing physician notes to identify patients' noncompliance to their Medications identified a larger proportion of patients who then self-reported poor Medication adherence than an automated EHR pull alone but was limited by the small number of patients identified. Optimizing the documentation of Medication adherence would maximize the utility of this automated approach to identify Medication noncompliance.

  • the minimal clinically important difference in Glaucoma Medication adherence interviews of Glaucoma experts
    Ophthalmic Research, 2021
    Co-Authors: Ajay Kolli, Shelby Danielwayman, Paula Anne Newmancasey
    Abstract:

    Poor adherence to Glaucoma Medications is associated with progressive vision loss. While many interventions have sought to increase Glaucoma Medication adherence, the amount by which adherence must increase to have a clinically significant effect remains unknown. To generate a hypothesized minimal clinically important difference (MCID) for Glaucoma Medication adherence, we conducted interviews with Glaucoma experts. Semi-structured interviews were conducted with members of the American Glaucoma Society. MCID was defined in 2 ways: (1) the incremental increase in the average percentage of eye drops a patient takes at roughly the correct time and (2) the incremental increase in the proportion of a patient population who attain good adherence. Good adherence was defined as taking more than 80% of drops at approximately the prescribed dose time. Expert opinions on the MCID for Glaucoma Medication adherence and open-ended responses were recorded through field notes. Twenty-five experts were interviewed. They estimated the MCID for average individual adherence levels as 17.7% (95% CI: 14.6, 20.8). Experts estimated the MCID for the proportion of patients in a practice who attain good adherence (defined as >80% of eye drops taken as prescribed) as 18.5% (95% CI: 15.6, 21.5). The most common identified themes were that the MCID should take into account the cost of the intervention and the burden to the ophthalmologist and to the practice, where experts thought that more costly interventions or those that required more physician time should have larger MCIDs. Based on expert opinion, we hypothesized that the MCID for Glaucoma Medication adherence is between 15 and 20%. However, the MCID for a given intervention must take into account several factors, including intervention cost and physician burden. This hypothesis may facilitate the design and implementation of future studies to objectively determine an MCID for Glaucoma Medication adherence.

Paul P Lee - One of the best experts on this subject based on the ideXlab platform.

  • comparison of Medication adherence assessment tools to identify Glaucoma Medication nonadherence
    Ophthalmology Glaucoma, 2021
    Co-Authors: Juno Cho, Michele Heisler, Paul P Lee, Leslie M Niziol, Ken Resnicow, David C Musch, Paula Anne Newmancasey
    Abstract:

    PURPOSE To assess the accuracy of 5 subjective self-assessment tools (3 adherence measures and 2 psychometric scales) and pharmacy refill data in predicting objective electronically monitored nonadherence. DESIGN Prospective cohort study. PARTICIPANTS Glaucoma patients (> 40 years old, >1 Medication with poor self-reported adherence) were recruited from University of Michigan Kellogg Eye Center for a study assessing the impact of a personalized Glaucoma coaching program on Medication adherence. METHODS Participants completed an initial assessment including 5 self-assessment tools and a 3-month period of electronic monitoring of Glaucoma Medication adherence (AdhereTech); pharmacy refill data were obtained. Electronically monitored adherence was calculated monthly as the percentage of doses taken on time. The median of these adherence rates was designated as baseline adherence. Patients with adherence of ≤80% by electronic monitoring were considered nonadherent. Self-assessment tools were scored, and pharmacy refill data were summarized as the proportion of days covered. Correlation between measures of adherence was estimated with Pearson and Spearman correlation coefficients. Receiver operating characteristic curves, including estimation of area under the curve (AUC), sensitivity, specificity, and accuracy were used to compare measures of adherence with respect to predicting electronically monitored nonadherence. MAIN OUTCOME MEASURES Accuracy of self-reported and pharmacy refill data adherence measures in predicting electronically monitored nonadherence. RESULTS Ninety-five patients completed 3 months of electronic monitoring with a median monthly adherence of 74 (± 21%); 53 patients (56%) were nonadherent. Pharmacy refill data were not correlated significantly with electronically monitored Medication adherence (r = 0.12; P = 0.2). Of all the measures, a single-item adherence question ("Over the past month, what percentage of your drops do you think you took correctly?") showed the largest correlation with median electronically monitored adherence (r = 0.47; P < 0.0001), largest AUC for predicting nonadherence (AUC = 0.76 [95% confidence interval [CI], 0.66-0.87]), best accuracy (71% [95% CI, 61%-82%]), and good sensitivity (84% [95% CI, 73%-96%]). CONCLUSIONS The single-item question was the most accurate in predicting electronically monitored nonadherence among participants with poor self-reported adherence. In clinical practice, where alternatives are too resource intensive, this free single-item screening question can help to identify Glaucoma patients at risk of poor Medication adherence with reasonable accuracy.

  • the impact of the support educate empower personalized Glaucoma coaching pilot study on Glaucoma Medication adherence
    Ophthalmology Glaucoma, 2020
    Co-Authors: Paula Anne Newmancasey, Paul P Lee, Leslie M Niziol, Ken Resnicow, David C Musch, Michele Heisler
    Abstract:

    Purpose To assess the efficacy of the Support, Educate, Empower (SEE) Glaucoma coaching program on Medication adherence among Glaucoma patients with low adherence. Design Uncontrolled intervention study with a pre–post design. Participants Glaucoma patients ≥ age 40, taking ≥1 Medication, who self-reported poor adherence were recruited from the University of Michigan Kellogg Eye Center. Adherence was monitored electronically for a 3-month baseline period; participants with median adherence of ≤80% were enrolled in the SEE program. Methods Participants' adherence was monitored electronically (AdhereTech, New York, NY) during the 7-month program. Adherence was calculated as the percentage of doses taken on time of those prescribed. The SEE program included (1) automated Medication reminders, (2) 3 in-person counseling sessions with a Glaucoma coach who had training in motivational interviewing (MI), and (3) 5 phone calls with the same coach for between-session support. The coach used a web-based tool to generate an education plan tailored to the patient's Glaucoma diagnosis, test results, and ophthalmologist's recommendations (www.Glaucomaeyeguide.org). The tool guided an MI-based conversation between coach and patient to identify barriers to adherence and possible solutions. Descriptive statistics were used to summarize baseline patient characteristics, and differences between those who did and did not complete the SEE program were tested with 2-sample t tests, chi-square tests, and Fisher exact tests. Adherence was compared before and after the SEE program with paired t tests. Main Outcome Measure Change in electronically monitored Medication adherence. Results A total of 48 participants were enrolled. The participants were 54% male, 46% white, and on average 64 years of age (standard deviation [SD], 10.8 years), with an average worse-eye mean deviation (MD) of –7.9 dB (SD, 8.8 dB). Those completing the SEE program (n = 39) did not differ significantly from those who dropped out (n = 9) on gender, race, age, MD, or baseline adherence. Medication adherence improved from 59.9% at baseline to 81.3% (P 80% on completing the SEE program. Conclusions The SEE program participants showed clinically meaningful, statistically significant improvement in Glaucoma Medication adherence.

  • access to and experiences with e health technology among Glaucoma patients and their relationship with Medication adherence
    Telemedicine Journal and E-health, 2018
    Co-Authors: Paula Anne Newmancasey, Alan L Robin, Paul P Lee, Olivia J Killeen, Morgan Renner, Michele Heisler
    Abstract:

    Abstract Background: As online health information becomes common, it is important to assess patients' access to and experiences with online resources. Introduction: We examined whether Glaucoma patients' technology usage differs by Medication adherence and whether adherence is associated with online education experiences. Materials and Methods: We included 164 adults with Glaucoma taking ≥1 Glaucoma Medication. Participants completed a survey including demographic and health information, the Morisky Adherence Scale, and questions about online Glaucoma resource usage. Differences in technology access, adherence, and age were compared with chi-squared, Fisher exact, and two-sample t-tests. Results: Mean age was 66 years. Twenty-six percent reported poor adherence. Eighty percent had good technology access. Seventy-three percent of subjects with greater technology access wanted online Glaucoma information and yet only 14% of patients had been directed to online resources by physicians. There was no relations...

  • patterns of Glaucoma Medication adherence over four years of follow up
    Ophthalmology, 2015
    Co-Authors: Paula Anne Newmancasey, Michele Heisler, Paul P Lee, Taylor Blachley, Karen B Farris, Joshua D Stein
    Abstract:

    Purpose To assess longer-term patterns of Glaucoma Medication adherence and identify whether patterns established during the first year of Medication use persist during 3 subsequent years of follow-up. Design Retrospective, longitudinal cohort analysis. Participants Beneficiaries aged ≥40 years who were enrolled in a United States (US)-managed care plan for ≥7 years between 2001 and 2012 and newly diagnosed and treated for open-angle Glaucoma. Methods For each enrollee, we quantified Medication adherence using the Medication possession ratio. Group-based trajectory modeling (GBTM) was applied to identify patterns of adherence for 1 and 4 years of follow-up. The percent of beneficiaries who remained in the same trajectory group in the 1- and 4-year models was tabulated to evaluate group stability. Factors impacting adherence at 1 and 4 years were identified using regression analyses. Main Outcome Measures Patterns of Glaucoma Medication adherence. Results Of the 1234 eligible beneficiaries, GBTM identified 5 distinct Glaucoma Medication adherence patterns in both the 1-year and 4-year follow-up periods. These groups were as follows: (1) never adherent after their index prescription fill (7.5% and 15.6% of persons in the 1- and 4-year models, respectively); (2) persistently very poor adherence (14.9% and 23.4% of persons in the 1- and 4-year models, respectively); (3) declining adherence (9.5% and 9.1% of persons in the 1- and 4-year models, respectively); (4) persistently moderate adherence (48.1% and 37.0% of persons in the 1- and 4-year models, respectively); and (5) persistently good adherence (20.0% and 15.0% of persons in the 1- and 4-year models, respectively). More than 90% of beneficiaries in the 4 groups with the worst and best adherence patterns (groups 1, 2, 3, 5) maintained their patterns from their first year throughout their 4 years of follow-up. Those with persistently moderate adherence (group 4), the largest group, were most likely to change groups from 1 to 4 years of follow-up. Persons with the best adherence over 4 years were more likely to be white, to be older, to earn >$60 000/year, and to have more eye care visits ( P P  = 0.03). Conclusions For most patients who were newly prescribed Glaucoma Medications, adherence patterns observed in the first year of treatment reflect adherence patterns over the subsequent 3 years. Investing resources in both identifying and helping patients with suboptimal adherence patterns over the first year may have a large impact on longer-term adherence.

  • subsequent receipt of interventions for Glaucoma among a nationwide sample of patients who underwent laser peripheral iridotomy
    American Journal of Ophthalmology, 2015
    Co-Authors: Surbhi Bansal, Jennifer S Weizer, Paul P Lee, Taylor Blachley, Asha S Balakrishnan, Joshua D Stein
    Abstract:

    Purpose To evaluate use of medical, laser, or incisional surgical interventions for Glaucoma after laser peripheral iridotomy (LPI). Design Retrospective longitudinal cohort study. Methods All enrollees aged ≥21 years in a US managed-care network who underwent bilateral LPIs in 2001–2011 were identified. The mean numbers of pre- and post-LPI Glaucoma Medication classes prescribed and the proportion of enrollees requiring cataract or Glaucoma surgery within 2 years after the LPIs were determined. Multivariable logistic regression assessed factors associated with enrollees' prescription of ≥1 Glaucoma Medication class after bilateral LPIs. Results Of the 1660 patients undergoing bilateral LPIs, 1280 (77.1%) had no pre- or post-LPI prescriptions for any Glaucoma Medication class. Of the remaining patients, 251 (66.1%) required more Glaucoma Medication classes after than before the procedures, whereas 44 (11.6%) used fewer after the procedures; 85 (22.4%) were prescribed the same number before and after the LPIs. A total of 167 patients (10.1%) underwent cataract surgery and 79 (4.8%) received Glaucoma surgery over the 2-year follow-up. Black patients had a 130% increased odds for Glaucoma Medication–class prescriptions after bilateral LPIs, compared with white patients ( P  = .02). The odds of post-LPI Glaucoma Medication use increased by 21% for every additional 5 years of age ( P Conclusion Most patients undergoing bilateral LPIs received no pre- or post-LPI Glaucoma Medication–class prescriptions and had no cataract or additional Glaucoma surgery within 2 years after LPIs. Clinicians should alert black or older patients and those already taking Glaucoma Medications before the procedure of their higher odds of requiring Medications afterward.

Kelly W Muir - One of the best experts on this subject based on the ideXlab platform.

  • improved Glaucoma Medication adherence in a randomized controlled trial
    Ophthalmology Glaucoma, 2021
    Co-Authors: Kelly W Muir, Jullia A Rosdahl, Aaron M Hein, Sandra Woolson, Maren K Olsen, Miriam A Kirshner, Malina Sexton, Hayden B Bosworth
    Abstract:

    Purpose To test the effectiveness of an intervention designed to improve Glaucoma Medication adherence. Design Randomized, controlled trial at a Veterans Affairs (VA) eye clinic. Participants Veterans with medically treated Glaucoma who reported poor adherence and their companions if applicable. Methods Participants, and their companions if applicable, were randomized to receive an intervention to improve Medication adherence that included Glaucoma education, personalized disease management suggestions, and a reminder aid, or the control arm that received education regarding general eye health. Main Outcome Measures The average proportion of prescribed Glaucoma Medication doses taken on schedule over the 6 months after randomization according to an electronic monitor between participants in the 2 arms. Results The mean proportion of prescribed doses taken on schedule was higher in the intervention group compared with controls (0.85 vs. 0.62, P Conclusions A multifaceted intervention can help improve Glaucoma Medication adherence.

  • the association of an upper extremity functional survey and Glaucoma Medication administration success
    Current Eye Research, 2019
    Co-Authors: Aaron M Hein, Kelly W Muir, Jullia A Rosdahl, Sandra Woolson, Maren K Olsen, Miriam A Kirshner, Hayden B Bosworth
    Abstract:

    Purpose/Aim: To determine if an upper extremity functional survey may identify which patients will have eye drop administration difficulty.Materials and Methods: Participants with Glaucoma treated ...

  • the relationship of self report and Medication possession with Glaucoma Medication administration success
    Journal of Glaucoma, 2019
    Co-Authors: Aaron M Hein, Jullia A Rosdahl, Sandra Woolson, Maren K Olsen, Miriam A Kirshner, Hayden B Bosworth, Kelly W Muir
    Abstract:

    Purpose:Many Glaucoma eye drop users cannot successfully self-administer drops, and observing patients’ drop technique can be time-consuming. We sought to examine the association of patient self-reported efficacy of eye drop technique and Medication possession data as potential surrogate measures fo

  • quantifying Glaucoma Medication adherence the relationship between self report electronic monitoring and pharmacy refill
    Journal of Ocular Pharmacology and Therapeutics, 2016
    Co-Authors: Jaya B Kumar, Betsy Sleath, Kelly W Muir, Sandra Woolson, Maren K Olsen, Hayden B Bosworth, Susanne Danus
    Abstract:

    Abstract Purpose: Glaucoma Medications reduce the risk of progressive visual field loss, but adherence to these Medications is often poor. A better understanding of the appropriate metrics for quantifying Glaucoma Medication adherence is needed. We describe and compare different means of quantifying Glaucoma Medication adherence. Methods: Adults with Glaucoma were enrolled in a prospective 2-site study. Participants completed a self-report instrument and received electronic Medication monitors to use for ∼3 months. Pharmacy records were queried regarding requested refills over the monitoring period; Medication possession ratio (MPR) was calculated. Results: Of the 137 total participants, those who answered “Very confident” to the question, “How confident are you that you always remember to use your Glaucoma Medications?” and “No” to the question, “In the past 4 weeks, did you ever forget to take your medicine?” were more likely [odds ratio (OR) 2.78, 95% confidence interval (CI) 1.19–6.52] to take ≥80% of...

  • applying the resources and supports in self management framework to examine ophthalmologist patient communication and Glaucoma Medication adherence
    Health Education Research, 2015
    Co-Authors: Betsy Sleath, Susan J Blalock, Delesha M Carpenter, Robyn Sayner, Kelly W Muir, Catherine Slota, Annette Giangiacomo, Mary Elizabeth Hartnett, Gail Tudor, Alan L Robin
    Abstract:

    Little is known about how ophthalmologist-patient communication over time is associated with Glaucoma patient long-term adherence. The purpose of our study was to examine the association between provider use of components of the resources and supports in self-management model when communicating with patients and adherence to Glaucoma Medications measured electronically over an 8-month period. In this longitudinal prospective cohort study, the main variables studied were ophthalmologist communication-individualized assessment, collaborative goal setting and skills enhancement. Patients with Glaucoma who were newly prescribed or on Glaucoma Medications were recruited from six ophthalmology clinics. Patients' baseline and next follow-up visits were videotape-recorded. Patients were interviewed after their visits. Patients used Medication event monitoring systems (MEMS) for 8 months after enrollment into the study, and adherence was measured electronically using MEMS for 240 days after their visits. Two hundred and seventy-nine patients participated. Patient race and regimen complexity were negatively associated with Glaucoma Medication adherence over an 8-month period. Provider communication behaviors, including providing education and positive reinforcement, can improve patient adherence to Glaucoma Medications over an 8-month period.

Joshua D Stein - One of the best experts on this subject based on the ideXlab platform.

  • text parsing based identification of patients with poor Glaucoma Medication adherence in the electronic health record
    American Journal of Ophthalmology, 2021
    Co-Authors: Mohammed Sami Hamid, Joshua D Stein, Leslie M Niziol, Autumn N Valicevic, Brianne Brenneman, Paula Anne Newmancasey
    Abstract:

    Purpose To assess the feasibility of automated text parsing screening of physician notes in the electronic health record (EHR) to identify Glaucoma patients with poor Medication compliance. Design Cross-sectional study. Methods An automated EHR extraction identified a cohort of patients at the University of Michigan with a diagnosis of Glaucoma, ≥40 years old, taking ≥1 Glaucoma Medication, and having no cognitive impairment. Self-reported Medication adherence was assessed with 2 validated instruments: the Chang scale and the Morisky Medication adherence scale. In tandem, a text parsing tool that abstracted data from the EHR was used to search for combinations of the following words in patient visit notes: “not,” “non,” “n't,” “no,” or “poor” accompanied by “adherence,” “adherent, “adhering,” “compliance,” “compliant,” or “complying.” The proportion of patients with self-reported poor adherence was compared between the EHR extraction and text parsing identification using a Fisher exact test. Results Among 736 participants, 20.0% (n = 147) self-reported poor adherence and 6.1% (n = 45) had EHR documentation of poor adherence (P Conclusions Text parsing physician notes to identify patients' noncompliance to their Medications identified a larger proportion of patients who then self-reported poor Medication adherence than an automated EHR pull alone but was limited by the small number of patients identified. Optimizing the documentation of Medication adherence would maximize the utility of this automated approach to identify Medication noncompliance.

  • text parsing based identification of patients with poor Glaucoma Medication adherence in the electronic health record
    American Journal of Ophthalmology, 2021
    Co-Authors: Mohammed Sami Hamid, Joshua D Stein, Leslie M Niziol, Autumn N Valicevic, Brianne Brenneman, Paula Anne Newmancasey
    Abstract:

    PURPOSE To assess the feasibility of automated text parsing screening of physician notes in the electronic health record (EHR) to identify Glaucoma patients with poor Medication compliance. DESIGN Cross-sectional study. METHODS An automated EHR extraction identified a cohort of patients at the University of Michigan with a diagnosis of Glaucoma, ≥40 years old, taking ≥1 Glaucoma Medication, and having no cognitive impairment. Self-reported Medication adherence was assessed with 2 validated instruments: the Chang scale and the Morisky Medication adherence scale. In tandem, a text parsing tool that abstracted data from the EHR was used to search for combinations of the following words in patient visit notes: "not," "non," "n't," "no," or "poor" accompanied by "adherence," "adherent, "adhering," "compliance," "compliant," or "complying." The proportion of patients with self-reported poor adherence was compared between the EHR extraction and text parsing identification using a Fisher exact test. RESULTS Among 736 participants, 20.0% (n = 147) self-reported poor adherence and 6.1% (n = 45) had EHR documentation of poor adherence (P < .0001). Using text parsing as a pre-screening tool, 22 of the 45 patients (48.9%) with non-adherence identified by text parsing also self-reported poor Medication adherence compared to the 20.0% by self-report overall (P < .0001). CONCLUSIONS Text parsing physician notes to identify patients' noncompliance to their Medications identified a larger proportion of patients who then self-reported poor Medication adherence than an automated EHR pull alone but was limited by the small number of patients identified. Optimizing the documentation of Medication adherence would maximize the utility of this automated approach to identify Medication noncompliance.

  • patterns of Glaucoma Medication adherence over four years of follow up
    Ophthalmology, 2015
    Co-Authors: Paula Anne Newmancasey, Michele Heisler, Paul P Lee, Taylor Blachley, Karen B Farris, Joshua D Stein
    Abstract:

    Purpose To assess longer-term patterns of Glaucoma Medication adherence and identify whether patterns established during the first year of Medication use persist during 3 subsequent years of follow-up. Design Retrospective, longitudinal cohort analysis. Participants Beneficiaries aged ≥40 years who were enrolled in a United States (US)-managed care plan for ≥7 years between 2001 and 2012 and newly diagnosed and treated for open-angle Glaucoma. Methods For each enrollee, we quantified Medication adherence using the Medication possession ratio. Group-based trajectory modeling (GBTM) was applied to identify patterns of adherence for 1 and 4 years of follow-up. The percent of beneficiaries who remained in the same trajectory group in the 1- and 4-year models was tabulated to evaluate group stability. Factors impacting adherence at 1 and 4 years were identified using regression analyses. Main Outcome Measures Patterns of Glaucoma Medication adherence. Results Of the 1234 eligible beneficiaries, GBTM identified 5 distinct Glaucoma Medication adherence patterns in both the 1-year and 4-year follow-up periods. These groups were as follows: (1) never adherent after their index prescription fill (7.5% and 15.6% of persons in the 1- and 4-year models, respectively); (2) persistently very poor adherence (14.9% and 23.4% of persons in the 1- and 4-year models, respectively); (3) declining adherence (9.5% and 9.1% of persons in the 1- and 4-year models, respectively); (4) persistently moderate adherence (48.1% and 37.0% of persons in the 1- and 4-year models, respectively); and (5) persistently good adherence (20.0% and 15.0% of persons in the 1- and 4-year models, respectively). More than 90% of beneficiaries in the 4 groups with the worst and best adherence patterns (groups 1, 2, 3, 5) maintained their patterns from their first year throughout their 4 years of follow-up. Those with persistently moderate adherence (group 4), the largest group, were most likely to change groups from 1 to 4 years of follow-up. Persons with the best adherence over 4 years were more likely to be white, to be older, to earn >$60 000/year, and to have more eye care visits ( P P  = 0.03). Conclusions For most patients who were newly prescribed Glaucoma Medications, adherence patterns observed in the first year of treatment reflect adherence patterns over the subsequent 3 years. Investing resources in both identifying and helping patients with suboptimal adherence patterns over the first year may have a large impact on longer-term adherence.

  • subsequent receipt of interventions for Glaucoma among a nationwide sample of patients who underwent laser peripheral iridotomy
    American Journal of Ophthalmology, 2015
    Co-Authors: Surbhi Bansal, Jennifer S Weizer, Paul P Lee, Taylor Blachley, Asha S Balakrishnan, Joshua D Stein
    Abstract:

    Purpose To evaluate use of medical, laser, or incisional surgical interventions for Glaucoma after laser peripheral iridotomy (LPI). Design Retrospective longitudinal cohort study. Methods All enrollees aged ≥21 years in a US managed-care network who underwent bilateral LPIs in 2001–2011 were identified. The mean numbers of pre- and post-LPI Glaucoma Medication classes prescribed and the proportion of enrollees requiring cataract or Glaucoma surgery within 2 years after the LPIs were determined. Multivariable logistic regression assessed factors associated with enrollees' prescription of ≥1 Glaucoma Medication class after bilateral LPIs. Results Of the 1660 patients undergoing bilateral LPIs, 1280 (77.1%) had no pre- or post-LPI prescriptions for any Glaucoma Medication class. Of the remaining patients, 251 (66.1%) required more Glaucoma Medication classes after than before the procedures, whereas 44 (11.6%) used fewer after the procedures; 85 (22.4%) were prescribed the same number before and after the LPIs. A total of 167 patients (10.1%) underwent cataract surgery and 79 (4.8%) received Glaucoma surgery over the 2-year follow-up. Black patients had a 130% increased odds for Glaucoma Medication–class prescriptions after bilateral LPIs, compared with white patients ( P  = .02). The odds of post-LPI Glaucoma Medication use increased by 21% for every additional 5 years of age ( P Conclusion Most patients undergoing bilateral LPIs received no pre- or post-LPI Glaucoma Medication–class prescriptions and had no cataract or additional Glaucoma surgery within 2 years after LPIs. Clinicians should alert black or older patients and those already taking Glaucoma Medications before the procedure of their higher odds of requiring Medications afterward.

  • impact of the introduction of generic latanoprost on Glaucoma Medication adherence
    Ophthalmology, 2015
    Co-Authors: Joshua D Stein, Nakul Shekhawat, Nidhi Talwar, Rajesh Balkrishnan
    Abstract:

    Purpose To assess possible changes in Medication adherence to prostaglandin analog (PGA) regimens among patients with open-angle Glaucoma (OAG) after the initial introduction of generic PGAs. Design Longitudinal cohort analysis. Participants Patients older than 40 years with OAG continuously enrolled in a nationwide managed-care network during 2009–2012 who used PGAs. Methods Mean adherence rates were calculated for topical PGA use during the 18 months before the introduction of generic latanoprost (September 2009–February 2011) and the 18 months after generic latanoprost became available (July 2011–December 2012). The rates were compared between persons who continued to use brand-name PGAs once generic latanoprost became available and others who switched to generic latanoprost. Multivariable logistic regression identified variables associated with an improvement or worsening of adherence of ≥25%. Main Outcome Measures Mean adherence rates and odds of 25% or more improved or worsened adherence (with 95% confidence intervals [CIs]). Results A total of 8427 patients met the study eligibility criteria. Compared with persons switching to generic latanoprost, patients who continued taking brand name PGAs were 28% less likely to have improved adherence (odds ratio [OR], 0.72; 95% CI, 0.55–0.94) and 39% more likely to have reduced adherence (OR, 1.39; 1.04–1.86) of ≥25%. Improved adherence after the generic drug's introduction was also associated with higher monthly Medication copay in the pregeneric period ( P = 0.02), lower copay after introduction of the generic drug ( P Conclusions Given that cost can significantly deter adherence, switching patients to generic Medications may help improve patients' drug-regimen adherence. A considerable number of patients discontinued Glaucoma drug use altogether when generic latanoprost became available. Ophthalmologists should work with insurers and pharmacists to prevent such discontinuation of use as generic forms of other PGA agents become available.

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  • comparison of Medication adherence assessment tools to identify Glaucoma Medication nonadherence
    Ophthalmology Glaucoma, 2021
    Co-Authors: Juno Cho, Michele Heisler, Paul P Lee, Leslie M Niziol, Ken Resnicow, David C Musch, Paula Anne Newmancasey
    Abstract:

    PURPOSE To assess the accuracy of 5 subjective self-assessment tools (3 adherence measures and 2 psychometric scales) and pharmacy refill data in predicting objective electronically monitored nonadherence. DESIGN Prospective cohort study. PARTICIPANTS Glaucoma patients (> 40 years old, >1 Medication with poor self-reported adherence) were recruited from University of Michigan Kellogg Eye Center for a study assessing the impact of a personalized Glaucoma coaching program on Medication adherence. METHODS Participants completed an initial assessment including 5 self-assessment tools and a 3-month period of electronic monitoring of Glaucoma Medication adherence (AdhereTech); pharmacy refill data were obtained. Electronically monitored adherence was calculated monthly as the percentage of doses taken on time. The median of these adherence rates was designated as baseline adherence. Patients with adherence of ≤80% by electronic monitoring were considered nonadherent. Self-assessment tools were scored, and pharmacy refill data were summarized as the proportion of days covered. Correlation between measures of adherence was estimated with Pearson and Spearman correlation coefficients. Receiver operating characteristic curves, including estimation of area under the curve (AUC), sensitivity, specificity, and accuracy were used to compare measures of adherence with respect to predicting electronically monitored nonadherence. MAIN OUTCOME MEASURES Accuracy of self-reported and pharmacy refill data adherence measures in predicting electronically monitored nonadherence. RESULTS Ninety-five patients completed 3 months of electronic monitoring with a median monthly adherence of 74 (± 21%); 53 patients (56%) were nonadherent. Pharmacy refill data were not correlated significantly with electronically monitored Medication adherence (r = 0.12; P = 0.2). Of all the measures, a single-item adherence question ("Over the past month, what percentage of your drops do you think you took correctly?") showed the largest correlation with median electronically monitored adherence (r = 0.47; P < 0.0001), largest AUC for predicting nonadherence (AUC = 0.76 [95% confidence interval [CI], 0.66-0.87]), best accuracy (71% [95% CI, 61%-82%]), and good sensitivity (84% [95% CI, 73%-96%]). CONCLUSIONS The single-item question was the most accurate in predicting electronically monitored nonadherence among participants with poor self-reported adherence. In clinical practice, where alternatives are too resource intensive, this free single-item screening question can help to identify Glaucoma patients at risk of poor Medication adherence with reasonable accuracy.

  • increased near activities function associated with increased Glaucoma Medication adherence among support educate empower see participants
    Journal of Glaucoma, 2021
    Co-Authors: Juno Cho, Michele Heisler, Leslie M Niziol, Paula Anne Newmancasey
    Abstract:

    Prcis Higher levels of near-vision related quality of life were associated with higher adherence to Glaucoma Medications after adjusting for important confounding variables among participants in the SEE personalized Glaucoma coaching pilot study. Purpose To investigate the association between vision-related quality of life (VRQoL) and Glaucoma Medication adherence. Materials and methods Subjects were recruited for the Support, Educate, Empower (SEE) program, a prospective non-controlled cohort study examining the impact of a personalized coaching program on Glaucoma Medication adherence. Glaucoma patients seen at the University of Michigan over 40 years old, taking ≥1 Glaucoma Medication, and self-reported poor adherence on two validated scales were recruited. Demographic details and VRQoL using the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) were collected. Participants' Medication use for each prescribed Glaucoma Medication was captured electronically using a Medication events monitoring system (Adheretech, New York, NY). The association between VRQoL and Medication adherence was assessed with Pearson's correlation coefficient (r) and linear regression. Results Among the 95 eligible participants 49.5% were female, 55.3% were Caucasian, and mean age (±standard deviation) was 63.8±10.5 years. Mean adherence to Glaucoma Medication was 73.8%±21.0%. Mean NEI VFQ-25 composite score was 81.6±14.5. Better Medication adherence was significantly and positively correlated with better functioning in domains of ocular pain (r=0.20, P=0.048), near activities (r=0.29, P=0.004), and role difficulties (r=0.22, P=0.036). Linear regression models adjusting for known correlates of Medication adherence (age, gender, race, income), showed a 10-unit increase in self-perceived near activities function was associated with a 2.2% increase in Medication adherence (95% confidence interval 1.0%-5.4%; P=0.0056). Conclusion Better self-perceived near activities function was associated with increased Glaucoma Medication adherence.

  • the impact of the support educate empower personalized Glaucoma coaching pilot study on Glaucoma Medication adherence
    Ophthalmology Glaucoma, 2020
    Co-Authors: Paula Anne Newmancasey, Paul P Lee, Leslie M Niziol, Ken Resnicow, David C Musch, Michele Heisler
    Abstract:

    Purpose To assess the efficacy of the Support, Educate, Empower (SEE) Glaucoma coaching program on Medication adherence among Glaucoma patients with low adherence. Design Uncontrolled intervention study with a pre–post design. Participants Glaucoma patients ≥ age 40, taking ≥1 Medication, who self-reported poor adherence were recruited from the University of Michigan Kellogg Eye Center. Adherence was monitored electronically for a 3-month baseline period; participants with median adherence of ≤80% were enrolled in the SEE program. Methods Participants' adherence was monitored electronically (AdhereTech, New York, NY) during the 7-month program. Adherence was calculated as the percentage of doses taken on time of those prescribed. The SEE program included (1) automated Medication reminders, (2) 3 in-person counseling sessions with a Glaucoma coach who had training in motivational interviewing (MI), and (3) 5 phone calls with the same coach for between-session support. The coach used a web-based tool to generate an education plan tailored to the patient's Glaucoma diagnosis, test results, and ophthalmologist's recommendations (www.Glaucomaeyeguide.org). The tool guided an MI-based conversation between coach and patient to identify barriers to adherence and possible solutions. Descriptive statistics were used to summarize baseline patient characteristics, and differences between those who did and did not complete the SEE program were tested with 2-sample t tests, chi-square tests, and Fisher exact tests. Adherence was compared before and after the SEE program with paired t tests. Main Outcome Measure Change in electronically monitored Medication adherence. Results A total of 48 participants were enrolled. The participants were 54% male, 46% white, and on average 64 years of age (standard deviation [SD], 10.8 years), with an average worse-eye mean deviation (MD) of –7.9 dB (SD, 8.8 dB). Those completing the SEE program (n = 39) did not differ significantly from those who dropped out (n = 9) on gender, race, age, MD, or baseline adherence. Medication adherence improved from 59.9% at baseline to 81.3% (P 80% on completing the SEE program. Conclusions The SEE program participants showed clinically meaningful, statistically significant improvement in Glaucoma Medication adherence.

  • patient experience during the support educate empower Glaucoma coaching program to improve Medication adherence a pilot study
    Ophthalmology Glaucoma, 2020
    Co-Authors: Cecilia N Hollenhorst, Michele Heisler, Ken Resnicow, Vanessa Elliott, Kevin S Schneider, Paula Anne Newmancasey
    Abstract:

    Purpose To understand patients’ qualitative experiences with the Support, Educate, Empower (SEE) personalized Glaucoma coaching program, provide a richer understanding of the components of the intervention that were useful in eliciting behavior change, and understand how to improve the SEE Program. Design A concurrent mixed-methods process analysis. Participants Thirty-nine patients with a diagnosis of any kind of Glaucoma or ocular hypertension who were aged ≥40 years, were taking ≥1 Glaucoma Medication, spoke English, self-administered their eye drops, and had poor Glaucoma Medication adherence (defined as taking ≤80% of prescribed Medication doses assessed via electronic Medication adherence monitors) who completed the 7-month SEE Program. Methods All participants who completed the study were interviewed in-person using a semistructured interview guide after the intervention. Coders conducted qualitative analysis of transcribed interviews using Grounded Theory. Participants were then stratified into groups based on change in adherence, and thematic differences between groups were examined. Main Outcome Measures Themes that emerged from interviews categorized by the number of participants who expressed a theme and the number of representative citations. Results Participants expressed positive views toward the program overall (95%, n = 37/39). They perceived program components as working together to improve their Medication adherence. Interactions with the Glaucoma coach (38 participants, 184 citations), motivation to aid personal change (38 participants, 157 citations), personalized Glaucoma education (38 participants, 149 citations), electronic reminders, and hearing their adherence score (37 participants, 90 citations) were most commonly cited by participants as helpful program elements contributing to improved adherence. Patients expressed a desire for personalized education to be a standard part of Glaucoma care. Participants who demonstrated more improvement in adherence had a more trusting attitude toward the adherence score and a greater magnitude of perceived personal need to improve adherence. Conclusions Participants reported a highly positive response to the in-person Glaucoma education and motivational interviewing intervention used in conjunction with automated adherence reminders.

  • psychosocial predictors of Glaucoma Medication adherence among the support educate empower see personalized Glaucoma coaching pilot study participants
    American Journal of Ophthalmology, 2020
    Co-Authors: Mariam Salman, Michele Heisler, Christopher A Andrews, Deborah Darnleyfisch, Paula Anne Newmancasey
    Abstract:

    Purpose To evaluate the association between baseline psychosocial milieu and subsequent Glaucoma Medication adherence among participants in the Support, Educate, Empower (SEE) personalized Glaucoma coaching program pilot study. Design Prospective cohort study. Methods Participants (University of Michigan Glaucoma patients aged ≥40 years, taking ≥1 Glaucoma Medication, who self-reported poor adherence) completed a baseline survey that assessed the following: (1) demographics; (2) social network; (3) perceived stress; (4) consideration of future consequences; (5) Glaucoma-related distress; and (6) social support. Medication adherence was then monitored electronically for 3 months and the percentage of prescribed doses taken was calculated. The relationship between baseline factors and Medication adherence was assessed using univariate and multivariate analysis. Main outcome measure was median percent adherence over 3 months. Results Of the 95 study participants, 63% had graduated from college, 55% were white, 35% were African-American, and 97% had insurance. Median adherence over 3 months was 74% ± 21% (±standard deviation, SD). Higher income and more education were significantly associated with better adherence (P Conclusions Lower income, lower educational attainment, and a higher level of Glaucoma-related distress all predicted lower adherence to Glaucoma Medications. Additional Glaucoma self-management support resources should be directed toward patients with such risk factors for poor adherence.