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

Importance: 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. Objective: To compare the Support, Educate, Empower (SEE) intervention with standard written education on glaucoma medication adherence. Design, Setting, and Participants: 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. Intervention: 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. Main Outcomes and Measures: 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. Results: 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. Conclusions and Relevance: 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. Trial Registration: ClinicalTrials.gov Identifier: NCT04735653.