“Postoperative medication compliance before and after the introduction of medication administration instruction sheet in patients who underwent cataract extraction surgery” Stylianos A Kandarakis M.D. 1,2, Neel Kumar M.D. 1,2, Winston Garris 1,2, Robert Routh 1,2, Allison Babuich 1,2, Nick Frame 1,2, Joshua Groetsch 1,, H. Sprague Eustis 2 Louisiana State University Health Science Center, Department of Ophthalmology New Orleans, LA 1 ; Ochsner Health System, New Orleans, LA 2 EQUIP Project Ophthalmology Department LSU/Ochsner

1.To assess the postoperative medication compliance in patients who underwent cataract extraction surgery in LSU System Hospitals. 2. To determine whether the introduction of medication administration instruction sheet will improve the postoperative medication compliance in patients who underwent cataract extraction surgery in LSU System Hospitals. Purposes

Double-site, prospective, observational study. The study group consisted of one hundred twenty patients who had recent (less than 30 days) cataract extraction surgery Patients were divided into two groups (n=60). In Group A, compliance of medication use was recorded on postoperative day 7 and 30. In Group B, the patients were given a set of instructions after surgery and compliance was similarly recorded. Methods

YOUR POSTOPERATIVE MEDICATIONS Start taking this medication 4 times/ a day for the 1 st week Then start tapering as following: 3 times/ a day for the 2 nd week 2 times/ a day for the 3 rd week 1 time/ a day for the 4 th week And then stop (medication comes in white or pink top) Start taking this medication 4 times/ a day for the 1 st week, then stop (medication comes in tan/beige top) Start taking this medication 4 times/ a day for the 1 st week, then stop (medication comes in grey top) Instruction Sheet

POST-OP COMPLIANCE DAY 1 YES NO DAY 7 YES NO DAY 30 YES NO Non-adherence was defined as: 1.Omission of drug use for more than 1 day or 2.2. Omission of the use of one of the three postoperative medications Recording Compliance

In Group A (without instruction sheet), 46 out of 60 patients were compliant and compliance was recorded at 80%. In Group B (with instruction sheet), 52 out of 60 patients were compliant and compliance was recorded at 90%. Results

In Group A the compliance 7 days and 30 days after surgery was recorded at 80% (24/30) and 73.3% (22/30) accordingly. In Group B the compliance 7 days and 30 days after surgery was recorded at 90% (27/30) and 83.3% (25/5) accordingly. Results

Compliance Group A (without instruction sheet) Group B (with instruction sheet) p value OR Days 724/30 (80%)27/30 (90%) 0.47 (ns) 0.44 Days 3022/30 (73.3%)25/30 (83.3%) 0.53 (ns) 0.55 Total46/60 (76.7%)52/60 (86.7%) 0.24 (ns) 0.51 p value OR 0.76 (ns) (ns) 1.8 No statistically significant difference in compliance was evident when comparing the two different Groups. No statistically significant difference in compliance was evident when comparing compliance in postoperative day #7 and day #30 between Group A and Group B. Results

Medication compliance is a crucial parameter in preventing and treating ophthalmologic diseases. Increasing medication compliance remains a challenge for most ophthalmologists and multiple measures have been used (reminders, pictograms, educational videos). In our study using patient’s self report, the compliance before and after the introduction of medication administration instruction sheet, was recorded at 80% and 90% accordingly. No significant difference was evident, though a trend for increase compliance was evident in the Group that the instruction sheet was used. A trend for reduced compliance was also noticed depending on the duration of postoperative period (7 days postop vs 30 days postop) in both Groups. Conclusions

1)Compliance barriers in glaucoma: a systematic classification. Tsai JC, McClure CA, Ramos SE, Schlundt DG, Pichert JW. Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA. 2)Effects of pictograms in educating 3 distinct low-literacy populations on the use of postoperative cataract medication. Braich PS,Almeida DR,Hollands S, Coleman MT Ross University School of Medicine, Dominica, West Indies. 3)Impact of a health communication intervention to improve glaucoma treatment adherence. Results of the interactive study to increase glaucoma adherence to treatment trial. Glanz K, Beck AD, Bundy L, Primo S, Lynn MJ, Cleveland J, Wold JA, Echt KV. Perelman School of Medicine and School of Nursing, University of Pennsylvania, Philadelphia, USA. 4)Effect of written instructions on accuracy of self- reporting medication regimen in glaucoma patients. Kharod BV, Johnson PB, Nesti HA, Rhee DJ. William and Anna Goldberg Glaucoma Service, Wills Eye Hospital, Philadelphia, PA, USA. References