Provider use of collaborative goal setting with glaucoma patients.

Glaucoma is a chronic asymptomatic disease like high blood pressure is. In glaucoma, the goal is to reduce the intraocular pressure in the eye.1 The American Academy of Ophthalmology Preferred Practice Pattern for Primary Open-Angle Glaucoma states that intraocular pressure can be lowered by medical treatment (e.g. medications, laser therapy, or incisional glaucoma surgery).2 Medical treatment and laser therapy are the most commonly accepted initial interventions to lower IOP in glaucoma patients.3 Each topical class of glaucoma medications has different side effects profiles and some patients may tolerate certain side effects better than others.4-8 Additionally, eye drops are often difficult to administer.7,9,10 Therefore, it becomes important for providers to discuss different treatment options with patients because some may tolerate certain medications and dosing regimens better than others.11 Wu et al.1 found that glaucoma self-management behavior was significantly associated with vision-related quality-of-life. Self-management behavior is critical when managing chronic diseases.12 Glaucoma is different than other chronic diseases in that eye drop instillation is usually needed and this is a lifelong disease in which many patients have to manage the condition over time by taking their prescribed eye drops with the ultimate goal of constant reduction of intraocular pressure and vision preservation.1. This chronic nature of the disease is compounded by potential side effects.11 One framework that has been applied to improving self-management behavior in individuals with chronic diseases is the Resources and Supports for Self-Management (RSSM).12 This framework emphasizes two key components that are important for providers to use when patients are newly diagnosed with a chronic disease: (1) individualized assessment and (2) collaborative goal setting. Individualized assessment involves exploring the patient's personal and cultural perspective on the chronic disease and how it will impact their life.12,13 Conducting an individualized assessment with newly diagnosed glaucoma patients might be important to better understanding patients’ views of glaucoma and glaucoma treatment options, which is important since these views could impact patient adherence. Collaborative goal setting involves empowering patients and asking for their input when treatment decisions are being made.12 Collaborative goal setting is being applied in several different disease states such as cardiac rehabilitation,14,15 asthma,16 osteoporosis ,17 psychiatry,18 and diabetes.13,19 Since there are different treatment choices for the initial treatment of glaucoma such as laser therapy or medications (prostaglandin analogs, beta-blockers), engaging in collaborative goal setting can help eye care providers pick the treatment options that are most favored by the patients. To our knowledge, no one has previously examined the extent to which eye care providers utilize collaborative goal setting and conduct an individualized assessment when prescribing glaucoma medications for the first time. Therefore, the purpose of our study was to conduct a preliminary study to examine: (a) the extent to which providers used collaborative goal setting and individualized assessment with patients who are newly prescribed glaucoma medications and (b) how patient age, gender, race, and literacy are associated with whether providers used collaborative goal setting and individualized assessment.