Interventions for Glaucoma Medication Adherence Improvement: A Network Meta-analysis of Randomized Controlled Trials

Area of Science:

• Ophthalmology
• Pharmacology
• Health Services Research

Background:

• High adherence to ocular hypotensive therapy is crucial for preventing vision loss in glaucoma patients.
• While various interventions exist to enhance medication adherence, their comparative effectiveness remains unclear.

Purpose of the Study:

• To compare the effectiveness of different interventions aimed at improving adherence to glaucoma medications.
• To identify the most effective strategies for enhancing medication adherence in glaucoma management.

Main Methods:

• A network meta-analysis (NMA) was conducted on randomized controlled trials (RCTs) evaluating interventions for ocular hypotensive therapy adherence.
• Eleven intervention categories, including standard of care (SOC), were compared using standardized mean differences (SMDs) and ranked by P-scores.
• Trial quality was assessed using the Cochrane risk-of-bias tool, and confidence in results was evaluated by Confidence in Network Meta-analysis.

Main Results:

• Tailored care, involving needs assessment and a personalized plan, significantly improved adherence compared to SOC (SMD, 1.28; P-score, 0.810).
• Multifaceted interventions including tailored care demonstrated further improvements: tailored care + multimedia education (SMD, 1.44; P-score, 0.850) and tailored care + multimedia education + device reminder (SMD, 1.61; P-score, 0.914).
• The ranking of interventions by effectiveness (P-score) placed tailored care and its combinations at the top, followed by incentives and short message service.

Conclusions:

• Network meta-analysis indicates that tailored care is superior to standard of care for improving glaucoma medication adherence.
• A multifaceted approach, particularly combining tailored care with educational and reminder strategies, may offer enhanced benefits for patient adherence.