Can better communication improve Black glaucoma patient outcomes?

Black patients who reviewed a list of questions and watched a video about glaucoma before a doctor’s visit set themselves up for better care and communication with medical care providers, a UNC Eshelman School of Pharmacy study shows.

Glaucoma, a set of eye conditions that can damage the optic nerve, is the leading cause of irreversible blindness in African American patients.

To improve outcomes for Black glaucoma patients, Betsy Sleath, George H. Cocolas Distinguished Professor in the school’s pharmaceutical outcomes and policy division, is focused on health care communication. In 2017, her team received a grant worth nearly $1.6 million from the Agency for Healthcare Research and Quality to help reduce vision problems in African Americans caused by glaucoma.

Betsy Sleath

In prior work, Sleath’s team found that Black patients were significantly less likely to be educated about glaucoma by their ophthalmologists and were significantly less likely to be adherent to their glaucoma medications than white patients. These findings are especially important given that African American eye care patients are more likely to be interested in learning about glaucoma than other races.

In her most recent study, she wanted to find out how to help doctors focus on what Black patients wanted to know about glaucoma, so she led an interdisciplinary team that conducted a large randomized controlled trial to increase African American question-asking during glaucoma visits and improve patient outcomes.

In order to increase question-asking for African American patients, the team worked with Black glaucoma patients to develop a list of 22 common questions about glaucoma and its treatment that patients might want to ask their doctor. Prior use of question prompt lists for cancer patients has been shown to increase the number of questions that they asked doctors, improve patient recall of information and prompt doctors to give patients more information.

In addition to the question prompt list, the team created a short educational video that stressed the importance of patient involvement during glaucoma visits that patients watch immediately before visits.

“We hypothesized that African American patients with glaucoma in the intervention group would have significantly improved communication with their ophthalmologists, and this improved communication would improve glaucoma medication self-efficacy, adherence and intraocular pressure,” Sleath said.

To test this hypothesis, the team undertook a randomized controlled trial. A group of 189 African American patients with glaucoma was enrolled in the trial and each patient randomly assigned to either a usual care or intervention group. In the intervention group, patients watched the video and received the question prompt list to use during their visits, while in the usual care group they did not. The visits were audio-taped, and patients were interviewed afterwards.

The intervention was highly effective. The team found that the pre-visit intervention increased patient question-asking about glaucoma and glaucoma medications and provider education about glaucoma.

“We hope this leads to an improvement in patient intraocular pressure so that a patient’s glaucoma does not get worse or lead to blindness,” said Sleath.

Among their findings, patients in the intervention group were significantly more likely to ask one or more questions about glaucoma than patients in the usual care group. Patients in the intervention group were also significantly more likely to ask one or more questions about glaucoma medications than patients in the usual care group. These patients were also significantly more likely to receive more areas of education about glaucoma from their providers during visits. Finally, patients who asked one or more questions about glaucoma medications were significantly more likely to receive more areas of education about glaucoma medications from providers.

Sleath and her team emphasized that their research is not yet finished. “The current manuscript only examined whether our intervention increased African American patient question-asking about glaucoma and provider education at the baseline visit,” said Sleath. “We are now following patients for 12 months to see if the intervention and increased patient question-asking and provider education leads to improved adherence (measured electronically) and intraocular pressure.”

The research team includes Delesha Carpenter, associate professor and interim chair of the pharmaceutical outcomes and policy division; Scott A. Davis, assistant professor; Nacire Garcia, social research specialist; Abena Adjei, research assistant; Dr. Charles Lee, CEO of Alexor, LLC; Dr. Donald L. Budenz, Kittner Family Distinguished Professor and chair of the UNC School of Medicine ophthalmology department; Dr. Alan Robin, executive vice president of the American Glaucoma Society; Dr. Kelly Muir, associate professor of ophthalmology at Duke University School of Medicine; Dr. Maria S. Romero, CEO of Precision Eye Care in Baltimore, Maryland; and Gail Tudor, director of public health at Southern New Hampshire University.