점안약 차트 교육을 통한 녹내장 환자의 약물 순응도 향상
Adherence Improvement in Glaucoma Patients: Effects of Educational Intervention Using an Eye Drop Chart
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목적: 안압하강제를 사용하는 녹내장 환자들을 대상으로 점안약 차트를 이용한 교육이 장기적인 순응도 향상에 미치는 효과를 알아보고자 한다. 대상과 방법: 본 연구는 전향적 다기관 연구로, 안압하강제를 사용 중인 녹내장 환자를 대상으로 점안약 차트를 통하여 올바른 안약 점안 방법을 교육하였다. 점안약 차트 사용 전과 3개월, 6개월 후 설문조사를 시행하여 안약 점안 수행성적(performance score)을 조사하여 순응도의 변화를 분석하고 순응도 향상에 영향을 주는 요인을 분석하였다. 또한, 3개월째 무작위로 안약 점안 방법과 점안약 차트 사용법에 대해 재교육을 실시하여 순응도에 주는 영향을 분석하였다. 결과: 점안약 개수가 적을수록, 연평균 소득과 교육수준이 높을수록, 도시에 주거하는 경우 높은 순응도와 유의한 관련을 보였다(p=0.038, p=0.033, p=0.041, p=0.047). 6개월간 점안약 차트 사용 후 평균안압은 14.3 ± 2.9 mmHg에서 12.4 ± 3.1 mmHg로 유의하게 감소하였고, 수행성적은 23.05 ± 3.52에서 21.30 ± 3.95로 순응도가 유의하게 향상하였다(p<0.001, p=0.021). 다변량분석에서 주 활동영역이 실내이고, 3개월째 점안약 차트를 재교육한 경우 순응도 향상을 보였다(odds ratio [OR]=5.47 p=0.032; OR=4.53 p=0.030). 결론: 녹내장 환자에서 점안약 차트 사용은 안압하강 및 순응도 향상에 효과적인 보조 방법이며, 주로 실내에서 활동하는 환자에서 효과적이었다. 점안약 차트 사용법에 대한 재교육을 통해 효과를 지속적으로 향상시킬 수 있었다.
Abstract
Purpose: To evaluate the effects of an educational intervention using an eye drop chart and supplementary education on glaucoma patients’ adherence. Methods: In this multicenter prospective study, medically treated glaucoma patients were educated on the administration of eye drops using an eye drop chart. At the time of recruitment, all of the patients completed a questionnaire on demographic characteristics and adherence. Three months after the initial educational intervention, the patients were randomly divided into two groups: an education group and a control group. The education group received supplementary education. Immediately thereafter and at 6 months, all of the patients completed the questionnaire on adherence again. Changes in instillation behavior, the relationship between the adherence score and demographic characteristics, and factors contributing to an improvement in adherence and intraocular pressure were then analyzed. Results: The adherence scores were significantly higher in patients with fewer medications, a higher annual income and higher educational level, and an urban residence (p = 0.038, p = 0.033, p = 0.041 and p = 0.047, respectively). Education on the administration of eye drops and use of the eye drop chart improved adherence scores from 23.05 ± 3.52 to 21.30 ± 3.95 (p = 0.021) and significantly reduced the average intraocular pressure from 14.3 ± 2.9 to 12.4 ± 3.1 mmHg (p < 0.001). Working indoors (odds ratio [OR] = 5.47, p = 0.032) and supplementary education at 3 months (OR = 4.53, p = 0.030) were also correlated with improved adherence. Conclusions: An eye drop chart is an effective tool for improving adherence and intraocular pressure control in glaucoma patients. Improvement in adherence was especially notable in patients whose work predominantly involved indoor activity. The effectiveness of the eye drop chart was improved by supplementary education.
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