Browsing by Author "Torbit, Julie"

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    A Comparison of Objectively- and Subjectively-Measured Adherence in Glaucoma Patients of African Descent
    (Office of the Vice Chancellor for Research, 2015-04-17) Awan, Nabeel; Sutaria, Ankita; Bigatti, Silvia M.; Sirk, Emily; Hosty, Elizabeth; Payton, Chloe; Grow, Shelbi; Sutton, Bradley; Torbit, Julie; Racette, Lyne
    Purpose. Adherence to medical treatment of glaucoma is challenging. People of African descent (AD) have higher prevalence of open-angle glaucoma (OAG) and have been shown to have worse adherence. The goal of this prospective, observational study was to compare objectively- and subjectively-measured adherence in patients of African descent and to determine their relationship with self-efficacy. Methods. Twenty-one patients of AD diagnosed with OAG in the past five years were included in this study. Patients used a once-daily topical prostaglandin analog eye drop and self-administered their medication. Subjective adherence was assessed through self-report. Adherence was objectively measured using MEMS bottles. The cap of these bottles records the number of times the bottle is opened. Self-efficacy was assessed using the 10-item Glaucoma Medication Self-Efficacy scale and the 6-item Eye Drop Technique Self-Efficacy scale. MEMS adherence percentages were compared to self-reported adherence using a paired sample two-tailed t-test. To assess the relationship between objectively measured adherence and self-efficacy, patients were divided into 3 groups (n=7 each): high, medium and low adherence groups. The Chi-square test was used to determine whether differences in self-efficacy between the groups were present for each question on the two self-efficacy scales. Results. Subjectiveadherence (mean ± standard deviation) (97.34% ± 5.61) was significantly higher than objective adherence (66.34% ± 26.68) (p= 0.01). Of the 21 patients, 17 self-reported higher adherence levels than MEMS adherence levels. 4 patients with the highest levels of objectively measured adherence were the only patients to correctly estimate their adherence by self-report. Only one question was significantly associated with objective adherence: patients with high adherence were significantly more confident about taking their glaucoma medications when they do not experience symptoms (p = 0.04). Conclusions. Results showed that patients with higher adherence are more confident about using their eye drops in the absence of symptoms.
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    Does Knowledge of the Causes of Glaucoma Impact Adherence?
    (Office of the Vice Chancellor for Research, 2016-04-08) Diallo, Kadé; Bigatti, Silvia M.; Sutton, Bradley; Torbit, Julie; Racette, Lyne
    Purpose: Glaucoma is informally known as loss of sight due to the deterioration or damage to the optic nerve; some scientists claim to have identified the genes related to these causes. The most prevalent risk factor includes those of African descendant. We tested the hypothesis that the adherence level is higher in patients with more knowledge of their condition than those with none. Methods: A dataset of the first visit from a clinical diagnosis of open-angle glaucoma was retrieved, in which all the patients administered once-daily prostaglandin analog eye drops themselves. Participants were on average 60.38±9.93yrs of age and identified as African descendants; of the 29 patients, 16 self-identified as male and the rest female. Participants were specifically asked to “Please list in rank-order the three most important factors that you believe caused your illness”. We grouped the results into three different conditions: (1) those with at least on “true” (current factors that are widely accepted scientifically) risk factors vs those with none, (2) those who included race as a risk factor vs those who did not, and (3) those who listed any risk factors vs those with none. We compared the adherence within each condition using two-tailed t-test to calculate the “level of significance”. Results: Our results did not agree with our hypothesis. The values returned were: (1) 0.1244, (2) 0.3744, and (3) 0.2516. Because all three results were ≥ 0.05, our data displayed that there were no relationship between the groups. It meant that our outcomes were most likely a consequence of chance with no significance. Conclusions: Though our results were not consistent with our hypothesis, we were still able to come to a different deduction: whether or not individuals are educated on the causes of their conditions, their adherence will only improve if they decide it so.
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    Does Knowledge of the Risk Factors of Glaucoma Impact Adherence in patients of African descent?
    (Investigative Ophthalmology and Visual Science Journal, 2016) Diallo, Kade; Bigatti, Silvia; Sutton, Bradley; Torbit, Julie; Racette, Lyne
    Purpose : The first line of treatment for primary open-angle glaucoma (POAG) is the daily use of eye drops. Adherence to this regimen is known to be challenging for patients. While POAG is more prevalent in people of African descent (AD), worse adherence is reported in this high-risk population. The purpose of this prospective clinical study was to determine whether knowledge of the risk factors associated with glaucoma translates into better adherence. Methods : Twenty-nine patients with POAG were included in the study. Participants were on average 60.38±9.93 years of age, identified as being of AD by self-report and 16 were male. Adherence was measured using Medical Event Monitoring System (MEMS) bottles. The cap of these bottles electronically records the date and time at which the bottle is opened. Each participant filled out the Brief Illness Perception questionnaire in which they were asked to “Please list in rank-order the three most important factors that you believe caused your illness”. The adherence of patients who reported 1) at least one accurate risk factor was compared to that of patients who reported no accurate risk factor, 2) race as a risk factor was compared to that of patients who did not report race, and 3) any risk factor (accurate or inaccurate) was compared to that of patients who reported no risk factor. Groups were compared using two-tailed t-tests. Results : Patients who reported at least one accurate risk factor (n=18) had similar adherence (73.39±25.94%) to those who reported no accurate risk factor (n=11) (55.91±33.10%) (p=0.12). Patients who reported race as a risk factor (n=6) had similar adherence (76.50±24.94%) to those who did not report race (n=23) (64.22±30.64%) (p=0.37). Patients reported any risk factor (n=22) had similar adherence (70.36±26.89%) to those who reported no risk factor (n=7) (55.43±36.78%) (p=0.25). While there was an overall trend for higher adherence in patients with more knowledge, statistical significance was not reached in any of the comparisons. Conclusions : We hypothesized that knowledge of the risk factors of glaucoma would result in better adherence because this knowledge could reflect a better understanding of the disease and of the importance of adhering to treatment. Our results suggest that knowledge of the risk factors of glaucoma does not impact adherence. Future studies will investigate whether educating patients can improve adherence.
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    Impact of self-efficacy and demographic factors on adherence to treatment in glaucoma patients of African descent
    (Investigative Ophthalmology and Visual Science Journal, 2017) Alkhairy, Sameerah; Chu, Fang-I; Ramezani, Koosha; McIntyre, Elizabeth; Sutton, Bradley; Torbit, Julie; Bigatti, Silvia
    Purpose : To determine whether self-efficacy and demographic factors influence adherence to the medical treatment of glaucoma in patients of African descent. Methods : 37 patients with a clinical diagnosis of primary open-angle glaucoma were included in this cross-sectional study. All patients were of African descent, used self-administered once-daily prostaglandin analog eye drops. Adherence was measured in 34 patients during a one-month period (mean 28.8 days) using Medical Event Monitoring System (MEMS) caps. The caps of these bottles electronically record the date and time at which the bottle is opened. All patients completed the four following questionnaires: Q1) glaucoma medication self-efficacy scale, Q2) eye drop technique self-efficacy scale, Q3) reported adherence to medication questionnaire and Q4) brief illness perception questionnaire. All answers were treated as ordinal variable and total scores for each questionnaire were computed. The impact of these four self-efficacy scores on adherence was assessed using linear regression models. We also determined how demographic factors (age, gender, education, marital status, employment status, and income) modulated this relationship. Finally, we assessed the influence of these demographic factors on the self-efficacy scores. Results : The mean age was 60.89±9.81 and 45.95% of patients were female. Eye drop technique self-efficacy (Q2) had a borderline negative impact on adherence (slope=−3.64, p=0.05), such that higher self-efficacy resulted in lower adherence. This result was minimized by being older (p=0.03) or divorced/separated (p=0.04) compared to being single/widowed (increase in the impact of self-efficacy on adherence). Similarly, the relationship between glaucoma medication self-efficacy (Q1) and adherence was negatively modulated by being married/partnered (p=0.04) compared to being single/widowed (decrease in the impact of self-efficacy on adherence). A negative impact of being male was also observed on Q1 (score=−6.28, p=0.05). Conclusions : Overall, patients who were confident in how to administer their eye drops had worse adherence, but this effect was minimized in older and divorced individuals. Overall, being male had a negative impact on self-efficacy as it relates to glaucoma medication. These results suggest that the relationship between self-efficacy and adherence is complex and affected by several factors. This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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    A pilot study of the effectiveness of motivational interviewing to improve adherence to glaucoma treatment in patients of African descent
    (Investigative Ophthalmology and Visual Science Journal, 2015) Altaras, Ira; Bigatti, Silvia; Sirk, Emily; Hosty, Elizabeth; Payton, Chloe; Grow, Shelbi; Sutton, Bradley; Torbit, Julie; Idowu, Eniola; Racette, Lyne
    Purpose: The first line of treatment for open-angle glaucoma is the use of daily hypotensive eye drops to control intra-ocular pressure. Adherence to this treatment is known to be challenging for patients, and has been reported to be worse in patients of African descent (AD), a segment of the population that is disproportionately affected by the disease. Motivational interviewing (MI) can improve adherence and has been shown to be more effective in minority populations. The purpose of this prospective, longitudinal and interventional pilot study was to determine whether MI might improve adherence in glaucoma patients of AD. Methods: Thirteen patients of African descent (AD) who received a clinical diagnosis of open-angle glaucoma within the past five years were included in this study. All patients used once-daily prostaglandin analog eye drops and administered their medication. Adherence was measured using Medical Event Monitoring System (MEMS) bottles. The cap of these bottles electronically records the date and time at which the bottle is opened. At visit 1, patients were instructed to place their eye drop bottle in the MEMS bottle and to otherwise use their eye drops as usual. At the 4-weeks visit, baseline adherence was assessed. Patients with adherence levels below 75% (n=9) received an approximately 20-minutes MI intervention and those with adherence levels over 75% served as controls (n=4). At the 12-weeks visit, patients returned and the final adherence was assessed. The difference between baseline and final adherence was compared between the groups using one-tailed paired t-tests. Results: In the group who received MI, final adherence (67.9% ± 7.68) was significantly higher than baseline adherence (55.95% ± 22.16) (p=0.03). Adherence improved in all but one of these patients (the adherence of one patient decreased by 0.2%). In controls, no significant difference between baseline adherence (81.38% ± 5.52) and final adherence (82% ± 17.33) (p=0.46) was observed. In this group, adherence improved in two patients (by 11.3% and 10.7%) and decreased in two patients (by 3.6% and 15.9%). Conclusions: These preliminary results obtained in a small sample suggest that MI may be effective in improving adherence in glaucoma in patients of African descent.