Background: Improving adherence to ocular hypertension (OH)/glaucoma therapy is highly likely to prevent or\nreduce progression of optic nerve damage. The present study used a behaviour change counselling intervention to\ndetermine whether education and support was beneficial and cost-effective in improving adherence with glaucoma\ntherapy.\nMethods: A randomised controlled trial with a 13-month recruitment and 8-month follow-up period was conducted.\nPatients with OH/glaucoma attending a glaucoma clinic and starting treatment with travoprost were approached.\nParticipants were randomised into two groups and adherence was measured over 8 months, using an electronic\nmonitoring device (Travalert�® dosing aid, TDA). The control group received standard clinical care, and the intervention\ngroup received a novel glaucoma education and motivational support package using behaviour change counselling.\nCost-effectiveness framework analysis was used to estimate any potential cost benefit of improving adherence.\nResults: Two hundred and eight patients were recruited (102 intervention, 106 control). No significant difference in\nmean adherence over the monitoring period was identified with 77.2% (CI, 73.0, 81.4) for the control group and 74.8%\n(CI, 69.7, 79.9) for the intervention group (p = 0.47). Similarly, there was no significant difference in percentage\nintraocular pressure reduction; 27.6% (CI, 23.5, 31.7) for the control group and 25.3% (CI, 21.06, 29.54) for the\nintervention group (p = 0.45). Participants in the intervention group were more satisfied with information about\nglaucoma medication with a mean score of 14.47/17 (CI, 13.85, 15.0) compared with control group which was 8.51\n(CI, 7.72, 9.30). The mean intervention cost per patient was GB�£10.35 (less than US$16) and not cost-effective.\nConclusions: Adherence with travoprost was high and not further increased by the intervention. Nevertheless, the\nstudy demonstrated that provision of information, tailored to the individual, was inexpensive and able to achieve high\npatient satisfaction with respect to information about glaucoma medication. Measurement of adherence remains\nproblematic since awareness of study participation may cause a change in participant behaviour.
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