Improving adherence in glaucoma patients : a systematic review of patient education methods

Purpose: To explore the literature in order to describe the educational strategies aimed at improving adherence in glaucoma patients. Methods: Two investigators independently searched the Medline, Pubmed, Embase and Psychinfo databases using the terms [“glaucoma” (AND) “patient education”] (AND) “patient adherence”. Twenty-six articles met the inclusion criteria. The educational topics were identified and data were extracted concerning the clinical setting, the study design, group size, content source, and the time and personnel involved. Results: Ten of the reviewed articles referred to clinical trials; five to clinical interventions without evaluating efficacy; and eleven discussed general suggestions and practical advice. Of the 15 articles adequately describing features of an educational strategy, three concentrated on adherence; eight on knowledge and understanding; one on persistence and knowledge; one on the accuracy of self reporting medication regimens; one on knowledge and awareness; and one on memory. One article referred to a group programme; four to “one-on-one” programmes; six to individual programmes; two to both “one-on-one” and “individual” programmes; and two to individual and/or one-on-one and group sessions. When specified, the personnel involved were ophthalmic assistants (3), physicians (3) or nurses (2); researchers (1); one programme was based on a multidisciplinary team. The duration of the interventions ranged from six minutes to two hours. Discussion: There are few published papers concerning the education of glaucoma patients. The interventions vary widely in terms of educational content and in strategies and do not seem to follow the strategies used to educate patients with other chronic diseases.