title: Exploring the influence of patient-provider communication on intraocular pressure in glaucoma patients.
abstract: OBJECTIVE
  We examined whether six patient-provider communication behaviors directly affected the intraocular pressure (IOP) of glaucoma patients or whether patient medication adherence and eye drop technique mediated the relationship between self-efficacy, communication, and IOP.
  
  
  METHODS
  During an 8-month, longitudinal study of 279 glaucoma patients and 15 providers, two office visits were videotape-recorded, transcribed, and coded for six patient-provider communication behaviors. Medication adherence was measured electronically and IOP was extracted from medical records. We ran generalized estimating equations to examine the direct effects of communication on IOP and used bootstrapping to test whether medication adherence and eye drop technique mediated the effect of communication on IOP.
  
  
  RESULTS
  Provider education about medication adherence (B=-0.50, p<0.05) and inclusion of patient input into the treatment plan (B=-0.35, p<0.05) predicted improved IOP. There was no evidence of significant mediation.
  
  
  CONCLUSIONS
  The positive effects of provider education and provider inclusion of patient input in the treatment plan were not mediated by adherence and eye drop technique.
  
  
  CONCLUSIONS
  Providers should educate glaucoma patients about the importance of medication adherence and include patient input into their treatment plan.
authors.affiliation: Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Asheville, USA. Electronic address: dmcarpenter@unc.edu.
authors.forename: Delesha M
authors.initials: DM
authors.lastname: Carpenter
authors.affiliation: Department of Mathematics and Statistics, Husson University, Bangor, USA.
authors.forename: Gail E
authors.initials: GE
authors.lastname: Tudor
authors.affiliation: School of Medicine, Stanford University, Stanford, CA, USA.
authors.forename: Robyn
authors.initials: R
authors.lastname: Sayner
authors.affiliation: School of Medicine, Duke University, & Durham VA Medical Center, Durham, USA.
authors.forename: Kelly W
authors.initials: KW
authors.lastname: Muir
authors.affiliation: Wilmer Institute and Bloomberg School of Public Health; Johns Hopkins University, & University of Maryland, Baltimore, MD, USA.
authors.forename: Alan L
authors.initials: AL
authors.lastname: Robin
authors.affiliation: Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, USA.
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Blalock
authors.affiliation: John A. Moran Eye Center, University of Utah, Salt Lake City, USA.
authors.forename: Mary Elizabeth
authors.initials: ME
authors.lastname: Hartnett
authors.affiliation: School of Medicine, Emory University, Atlanta, USA.
authors.forename: Annette L
authors.initials: AL
authors.lastname: Giangiacomo
authors.affiliation: Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, USA.
authors.forename: Betsy L
authors.initials: BL
authors.lastname: Sleath
keywords: Eye drop technique; Glaucoma; Mediation analysis; Medication adherence; Patient-provider communication