Robyn Sayner

Child and caregiver involvement and shared decision-making during asthma pediatric visits.

Objective. The purpose of this study was to examine (1) the extent to which caregivers and children asked asthma management questions during pediatric asthma visits; (2) the extent to which providers engaged in shared decision-making with these caregivers and children; and (3) the factors associated with question asking and shared decision-making. Methods. Children aged 8–16 years with mild persistent asthma, moderate persistent asthma, or severe persistent asthma and their caregivers were recruited at five pediatric practices in non-urban areas of North Carolina. All of the medical visits were audio tape recorded. Generalized estimating equations were used to analyze the data. Results. Only 13% of children and 33% of caregivers asked one or more questions about asthma management. Caregivers were more likely to ask questions about their child’s medications. Providers obtained child input into their asthma management plan during only 6% of encounters and caregiver input into their child’s asthma management plan during 10% of visits. Conclusion. Given the importance of involving patients during healthcare visits, providers need to consider asking for and including child and caregiver inputs into asthma management plans so that shared decision-making can occur more frequently.

Accuracy of Patient-reported Adherence to Glaucoma Medications on a Visual Analog Scale Compared With Electronic Monitors

PURPOSE Glaucoma medications can improve clinical outcomes when patients adhere to their medication regimen. Providers often ask patients with glaucoma to self-report their adherence, but the accuracy of self-reporting has received little scientific attention. The purpose of this article was to compare a self-reported medication adherence measure with adherence data collected from Medication Event Monitoring Systems (MEMS) electronic monitors. An additional goal was to identify which patient characteristics were associated with overreporting adherence on the self-reported measure. METHODS English-speaking adult patients with glaucoma were recruited from 6 ophthalmology practices for this observational cohort study. Patients were interviewed after their initial visit and were given MEMS contains, which recorded adherence over a 60-day period. MEMS percent adherence measured the percentage of the prescribed number of doses taken. MEMS-measured timing adherence assessed the percent doses taken on time. Patients self-reported adherence to their glaucoma medications on a visual analog scale (VAS) ~60 days after the baseline visit. Bivariate analyses and logistic regressions were used to analyze the data. Self-reported medication adherence on the VAS was plotted against MEMS adherence to illustrate the discrepancy between self-reported and electronically monitored adherence. FINDINGS The analyses included 240 patients who returned their MEMS containers and self-reported medication adherence at the 60-day follow-up visit. Compared with MEMS-measured percent adherence, 31% of patients (n = 75) overestimated their adherence on the VAS. Compared with MEMS-measured timing adherence, 74% (n = 177) of patients overestimated their adherence. For the MEMS-measured percent adherence, logistic regression revealed that patients who were newly prescribed glaucoma medications were significantly more likely to overreport adherence on the VAS (odds ratio, 3.07 [95% CI, 1.22-7.75]). For the MEMS-measured timing adherence, being male (χ(2) test, 6.78; P = 0.009) and being prescribed glaucoma medications dosed multiple times daily (χ(2) test, 4.02; P = 0.045) were significantly associated with patients overreporting adherence. However, only male sex remained a significant predictor of overreporting adherence in the logistic regression (odds ratio, 4.05 [95% CI, 1.73-9.47]). IMPLICATIONS Many patients with glaucoma, especially those newly diagnosed, overestimated their medication adherence. Because patients were likely to overreport the percent doses taken and timing adherence, providers may want to ask patients additional questions about when they take their glaucoma medications to potentially detect issues with taking these medications on time.

Patient Question-Asking About Glaucoma and Glaucoma Medications During Videotaped Medical Visits

We applied the ecologic model of communication in medical consultations to examine how patient, physician, and situational/contextual factors are associated with whether patients ask one or more questions about glaucoma and glaucoma medications during visits to ophthalmologists. Patients with glaucoma who were newly prescribed or already on glaucoma medications were recruited at six ophthalmology clinics. Patients’ visits with their doctors were video-recorded and patients were interviewed after visits. Generalized estimating equations were used to analyze the data. Two hundred and seventy-nine patients participated. Patients asked one or more questions about glaucoma during 59% of visits and about glaucoma medications during 48% of visits. Patients who were newly prescribed glaucoma medications were significantly more likely to ask one or more questions about glaucoma and glaucoma medications. Whether providers asked patients if they had questions was not significantly associated with patient question-asking. Patients were significantly more likely to ask older providers questions about glaucoma medications and female providers questions about glaucoma. Eye care providers should encourage glaucoma patients to ask questions during their medical visits.

Glaucoma patient expression of medication problems and nonadherence.

Purpose The purpose of this study was to examine if patient demographic factors influenced self-reporting of medication side effects, difficulty with drop instillation, and nonadherence to glaucoma therapy. Methods English-speaking adult glaucoma patients (n = 279) from six ophthalmology clinics were enrolled. Patients’ medical visits were videotaped and patients were interviewed immediately afterward by research assistants. The videotapes were transcribed verbatim and coded to identify patients who expressed problems with medication side effects, eye drop administration, and nonadherence during the glaucoma office visits. Generalized estimating equations were performed to identify whether patient characteristics were associated with expression of problems with glaucoma medication and medication nonadherence during the office visit. Results Patients with lower health literacy were significantly less likely to express problems with side effects (odds ratio [OR], 0.47; 95% confidence interval [CI], 0.25 to 0.88) and eye drop administration (OR, 0.26; 95% CI, 0.11 to 0.63) during the visit. Patients who reported eye drop administration and side effect problems during the interview were significantly more likely to express these problems to their ophthalmologist (OR, 3.13; 95% CI, 1.82 to 5.37 and OR, 1.86; 95% CI, 1.12 to 3.08, respectively). Patients who expressed a problem with eye drop administration and with side effects were significantly more likely to express medication nonadherence to their ophthalmologist (OR, 2.89; 95% CI, 1.44 to 5.80 and OR, 2.03; 95% CI, 1.16 to 3.54, respectively). Patients who reported greater than 80% medication adherence during the interview were significantly less likely to express nonadherence to their ophthalmologist (OR, 0.22; 95% CI, 0.12 to 0.40). Conclusions Eye care providers should be aware that glaucoma patients with lower health literacy are less likely to express problems with side effects and eye drop administration. Providers should work with patients to assess medication-related problems to mitigate potential barriers to medication adherence because patients who expressed medication problems were also more likely to express nonadherence.

Communication predicts medication self-efficacy in glaucoma patients

Purpose Medication self-efficacy, or patients’ confidence that they can perform medication-related behaviors, is associated with better glaucoma medication adherence. Little is known about how to enhance glaucoma patients’ medication self-efficacy. Our purpose is to examine whether patient-provider communication increases glaucoma patients’ medication self-efficacy. Methods During an 8-month cohort study of 279 glaucoma patients and 15 providers, two office visits were videotape-recorded, transcribed, and coded for six patient-provider communication behaviors. A validated scale was used at baseline and 8-month follow-up to assess patients’ confidence in overcoming adherence barriers (adherence barriers self-efficacy) and carrying out tasks to use eye drops correctly (eye drop task self-efficacy). We ran two generalized estimating equations to examine whether more frequent patient-provider communication during office visits predicted increased patient adherence barriers self-efficacy and eye drop task self-efficacy at 8-month follow-up. Results For each additional topic providers educated about, patients reported an average increase of 0.35 in self-efficacy in overcoming adherence barriers (p < 0.001). Patients also reported an average increase of 1.01 points in eye drop task self-efficacy when providers asked about patients’ views of glaucoma and its treatment versus not (p < 0.001). Patients who asked more medication questions (p < 0.001) and African-American patients (p < 0.05) reported lower adherence barriers self-efficacy by 0.30 and 2.15 points, respectively. Women had a 0.63 lower eye drop task self-efficacy than men (p < 0.05). Conclusions When providers educate glaucoma patients and assess patient views about glaucoma and its treatment, patients report higher medication self-efficacy. Providers should be aware that patients who ask more medication questions may have less confidence in their ability to overcome barriers to adherence.

The Effect of Eye Drop Technique Education in Patients With Glaucoma

ABSTRACT Education about how to administer eye drops may improve a patient’s ability to instill his or her eye drops correctly. Our objectives were to (a) document the methods providers use to educate glaucoma patients about eye drop technique; (b) determine whether eye drop technique education varies by provider and patient characteristics; and (c) evaluate whether education predicts improved patient technique. We conducted an 8-month longitudinal study of 279 glaucoma patients and 15 providers in which we recorded on videotape the content of glaucoma office visits at two time points (baseline and 4- to 6-week follow-up) and videotaped patient eye drop technique at three time points (baseline, 4- to 6-week follow-up, and 8-month follow-up). Mann–Whitney rank sum tests were used to determine whether education was associated with improved patient eye drop technique over time. Ninety-four patients (34%) received technique education at either visit; 31% received verbal education and 10% received a technique demonstration. Only 24 patients (47%) who were new to eye drops received technique education at the baseline visit. Patients who were new to drops at baseline (p = .008) and patients who asked a question about drops (p < .001) were more likely to receive technique education. Education was not associated with improved technique. Eye drop technique education occurs infrequently during glaucoma office visits. Future studies should compare the effectiveness of different educational methods, such as patient demonstration versus provider verbal instruction, to determine which method is best at improving patient eye drop technique.

Provider use of collaborative goal setting with glaucoma patients

Purpose The purpose of this preliminary study was to describe the extent to which providers used collaborative goal setting and individualized assessment with patients who were newly prescribed glaucoma medications. Methods English-speaking glaucoma suspect patients from six ophthalmology clinics who were newly prescribed glaucoma medications had their medical visits videotaped and were interviewed after the visits. The videotapes were transcribed and coded to examine provider use of collaborative goal setting and individualized assessment. Results Fifty-one patients seeing 12 ophthalmologists participated. Providers gave patients glaucoma treatment options during 37% of the visits; only five providers gave patients treatment options Providers asked for patient treatment preferences in less than 20% of the visits; only two providers asked for patient treatment preferences. Providers were significantly more likely to ask African American patients for their preferences or ideas concerning treatment than non–African American patients (Pearson &;2 = 4.1, p = 0.04). Providers were also significantly more likely to ask African American patients about their confidence in using glaucoma medication regularly than non–African American patients (Pearson &khgr;2 = 8.2, p = 0.004). Providers asked about patient views about glaucoma in less than 20% of the visits; five providers asked patients their views on glaucoma and its treatment. Providers were significantly more likely to ask African American patients about their views on glaucoma than non–African American patients (Pearson &khgr;2 = 5.62, p = 0.02). Conclusions Eye care providers often did not use collaborative goal setting or conduct individualized assessments of patient views on glaucoma when prescribing treatment for the first time.

Online Information-Seeking Behaviors of Parents of Children With ADHD

This article describes (a) parent questions about ADHD (attention deficit/hyperactivity disorder), (b) parent Internet use to seek ADHD information, and (c) associations between type of Internet access and ADHD information-seeking. Seventy parents of children (ages 7-17 years) with ADHD completed questionnaires after their child’s visit with their pediatrician. Bivariate relationships were assessed using chi-square statistics, Pearson correlation coefficients, or t tests. Parents identified an average of 8.9 questions about ADHD for their child’s provider. Common questions were related to medication and long-term implications of ADHD. A majority of parents searched the Internet for general ADHD information (87%) and ADHD medication information (81%). White parents accessed the Internet significantly more via home computer, mobile phone, and tablet, and significantly less via public library than non-White parents. Parents who accessed the Internet via home computers and tablets were more likely to search the Internet for ADHD medication information than parents who did not.

Youth Views on Communication About ADHD and Medication Adherence

The purpose of this study was to examine youth perceptions of attention deficit hyperactivity disorder (ADHD) communication with their pediatric providers, their reported adherence to their ADHD medications, and their desired location for an ADHD educational program. Youth ages 7 through 17 with an ADHD diagnosis were recruited. A research associate interviewed the youth. Parents completed demographic questionnaires. Seventy families participated. One-third of the youth wanted more discussion about ADHD with their providers during visits. The average youth had over eight questions about ADHD and its treatment. Most youth wanted to learn about ADHD at their provider’s office. Non-white and older youth were significantly more likely to be less adherent to their ADHD medications. Youth want their providers to engage them more during visits. Providers should take advantage of this interest to engage youth more in discussions regarding ADHD and its treatment during pediatric ADHD visits.

Exploring the influence of patient-provider communication on intraocular pressure in glaucoma patients

OBJECTIVE We examined whether six patient-provider communication behaviors directly affected the intraocular pressure (IOP) of glaucoma patients or whether patient medication adherence and eye drop technique mediated the relationship between self-efficacy, communication, and IOP. METHODS During an 8-month, longitudinal study of 279 glaucoma patients and 15 providers, two office visits were videotape-recorded, transcribed, and coded for six patient-provider communication behaviors. Medication adherence was measured electronically and IOP was extracted from medical records. We ran generalized estimating equations to examine the direct effects of communication on IOP and used bootstrapping to test whether medication adherence and eye drop technique mediated the effect of communication on IOP. RESULTS Provider education about medication adherence (B=-0.50, p<0.05) and inclusion of patient input into the treatment plan (B=-0.35, p<0.05) predicted improved IOP. There was no evidence of significant mediation. CONCLUSION The positive effects of provider education and provider inclusion of patient input in the treatment plan were not mediated by adherence and eye drop technique. PRACTICE IMPLICATIONS Providers should educate glaucoma patients about the importance of medication adherence and include patient input into their treatment plan.