# Effect of the Support, Educate, Empower Personalized Glaucoma Coaching Program on Medication Adherence: The SEE Program Randomized Clinical Trial

## TL;DR

A personalized glaucoma coaching program significantly improved medication adherence and reduced distress compared to standard written education in patients with glaucoma.

## Contribution

The study introduces the SEE program, a motivational interviewing-based health coaching intervention that outperforms standard care in improving medication adherence for glaucoma.

## Key findings

- Participants in the SEE program had significantly better medication adherence (77.6%) compared to the control group (58.0%).
- More participants in the SEE group achieved 80% or greater adherence (54.9%) than the control group (23.7%).
- Glaucoma-related distress decreased more in the intervention group than in the control group.

## Abstract

Does a personalized, glaucoma health coaching program increase medication adherence compared with standard written education in adults with glaucoma and poor self-reported adherence?

In this parallel 1:1 randomized clinical trial (n = 235), participants who received the Support, Educate, Empower (SEE) intervention had clinically and significantly better medication adherence than those receiving standard written education. Glaucoma-related distress also decreased more in intervention participants.

This personalized intervention improved glaucoma medication adherence and glaucoma-related distress more than standard written education, which may confer both improvements in disease control and in quality of life.

This randomized clinical trial compares the use of the Support, Educate, Empower program with standard of care for medication adherence.

Medication nonadherence contributes to vision loss from glaucoma, a leading cause of irreversible blindness in the US. Intervention to improve adherence can benefit health outcomes and quality of life, while reducing health system and public health burden.

To compare the Support, Educate, Empower (SEE) intervention with standard written education on glaucoma medication adherence.

The SEE study was a parallel, nonmasked, 1:1 randomized clinical trial testing intervention superiority. Participants were recruited from the University of Michigan (UM) and Henry Ford Health System (HFHS) between April 27, 2021, and December 18, 2023. Adults with glaucoma taking 1 or more ocular hypotensive eye drop medications who self-reported adherence of 85% or lower were eligible.

The SEE intervention is a 6-month motivational interviewing-based glaucoma health coaching program administered by a nonphysician counselor, including 3 in-person sessions, 4 between-visit phone calls, personalized multimedia glaucoma education, and automated medication reminders. The control consisted of usual care and 3 mailings of standard written glaucoma education.

Medication adherence (primary outcome) was electronically monitored (AdhereTech) and calculated as the percentage of doses taken on time divided by those prescribed over the 6-month study period. Change in glaucoma-related distress (secondary outcome) was also investigated.

Of 236 participants enrolled (108 in UM and 128 in HFHS), 235 (mean [SD] age, 67.3 [10.9] years; 124 [53%] female) were randomized to the SEE intervention (n = 117) or control (n = 118). Participant characteristics were balanced between groups. Mean (SD) self-reported adherence was 63.9% (17.9%). Medication adherence was significantly better in the SEE intervention group compared with that among control participants (mean [SD], 77.6% [19.7%]; n = 113 vs 58.0% [25.2%]; n = 114; difference, 19.7%; 95% CI, 13.7 to 25.6; P < .001), and more achieved 80% or greater adherence (62 of 113 [54.9%] vs 27 of 114 [23.7%]; P < .001). The difference in change in glaucoma-related distress between intervention and control was −0.3 (95% CI, −0.5 to −0.1) after adjusting for baseline distress.

The SEE glaucoma coaching program improved glaucoma medication adherence and reduced glaucoma-related distress compared with standard written education. The SEE program represents an evidence-based method to improve medication adherence necessary to improve glaucoma outcomes.

ClinicalTrials.gov Identifier: NCT04735653