Improving glaucoma self-management with technology-supported counselors

a MiCDA Research Project Description

Investigators: Paula Anne Newman-Casey, Michele Heisler, Paul Lee, Kenneth Resnicow, Amy Ellen Mainville Cohn

Funding: National Eye Institute, 2016-2020 (1 K23 EY 025320 01 A1)

Glaucoma is the third leading cause of irreversible blindness in the United States, but at least one third of glaucoma patients do not take the medications that are proven to prevent vision loss. Current clinical practice lacks a strategic framework to address this issue. The overarching objective of this proposal is to improve adherence while maximizing the efficiency of our ophthalmic healthcare workforce. This can be accomplished by leveraging technology to allow medical assistants to deliver the sort of high-quality, individualized education and counseling that would otherwise be available only through an extended conversation with a physician. Due to the projected increase in the prevalence of glaucoma as the population ages and the concomitant projected shortage of ophthalmologists, providing health communication of this kind can only be sustainable if it is delivered by paraprofessionals. The goal of this work is to create the eyeGuide, a counseling protocol that will enable minimally trained medical assistants to motivate glaucoma patients to improve their self-management and medication
adherence. The protocol will be based in motivational interviewing, a counseling style that engages patients in discussing priorities and obstacles to facilitate intrinsic motivation to change health behavior. A key element of the program will be the development of the technology-based, tailored tool that will allow counselors to individualize the educational content of the intervention. These goals will be met through the following specific aims: 1) Develop the two key components of the eyeGuide program (the counseling protocol and tailored tool) through an iterative process involving key stakeholders in refining the intervention to increase its usability and the users? satisfaction; 2) Pilot test the program to evaluate its effect on medication adherence and psycho-social mediators of adherence among poorly adherent patients. Dr. Newman-Casey?s long-term goal is to become an expert in the use of motivational interviewing and health information technology to create scalable, sustainable models for improving chronic disease management in ophthalmology. The vast resources of the University of Michigan will enable her to access coursework in the theoretical basis for behavior change as well as the research methods necessary to measure the effectiveness of health-behavior interventions. She will also benefit from her inter-disciplinary mentorship team of experienced scientists and clinicians who are deeply committed to her success. As an
academic glaucoma specialist at the University of Michigan, she works in the ideal environment to transform research findings into clinical tools. Her clinical specialty will be treating glaucoma patients, while her research will focus on developing improved systems for health-care delivery in eye care.

Research Signature Theme:

Health and well-being in later life: Chronic Disease