A randomized, controlled trial to test the effectiveness of a glaucoma patient navigator to improve appointment adherence

Abstract

PurposePatients with glaucoma who do not keep their follow-up eye care appointments are at risk for developing more severe ocular disease. The primary aim of the current study was to evaluate whether the use of a patient navigator altered adherence to follow-up eye care appointments in community-versus office-based settings.Patients and methodsPatients diagnosed with a glaucoma-related condition following a comprehensive eye examination at 43 community sites in Philadelphia, PA, USA, were enrolled in this prospective, randomized, controlled trial. Patients were randomized into three groups for a 1-year period: Group 1 (G1) received follow-up eye care in a community-based setting with assistance from a patient navigator; Group 2 (G2) received follow-up eye care in an office-based setting with assistance from a patient navigator; and Group 3 (G3) received follow-up eye care in an office-based setting without a patient navigator (usual care). Adherence rates were compared among these three groups using a chi-squared test at a significance level of 0.05.ResultsA total of 155 patients with glaucoma-related diagnoses were enrolled. The mean age (±standard deviation) was 71.2 (±10.0) years. Patients were predominantly female (65.8%, n=102/155) and African-American (71.6%, n=111/155). The mean (±standard deviation) number of follow-up visits during the 1-year study period was 1.3 (±1.3) for G1, 1.6 (±1.3) for G2, and 1.3 (±1.1) for G3 (P=0.48). Appointment adherence, defined as attendance of ≥1 follow-up visit, was 69.8% (n=37/53) for G1, 82.5% (n=47/57) for G2, and 73.3% (n=33/45) for G3, (P=0.28). Sub-analysis of adherence rates for patients who attended ≥2 follow-up visits were 91.3% (n=21/23) for G1, 74.3% (n=26/35) for G2, and 66.7% (n=18/27) for G3, (P=0.11).ConclusionHelp from a patient navigator did not increase the likelihood of keeping ≥1 follow-up appointment in an office-based setting. Adherence rates for follow-up appointments reached close to 70% or above in a self-selected patient population.

Interventions to promote access to eyecare for non-dominant ethnic groups in high-income countries: a scoping review

“…'Patient navigators' likely fill a similar role to those who facilitate behavioural activation; they help guide patients through the steps of eyecare, providing support as needed. An initial randomised controlled trial (RCT) evaluating effectiveness of adding patient navigators within an already supportive eyecare programme showed inconclusive results 72 but a follow-up RCT is underway. [73][74][75] Hiring school nurses to help students navigate from screening to full eye exams and comply with treatment was reported to be effective compared with screening alone 76 (although some universal childhood screening programmes were very effective at promoting follow-up).…”

Lessons Learned From 2 Large Community-based Glaucoma Screening Studies

“…(d) The PTGDF found that patient navigators and social workers improved timely attendance at the first followup after the confirmatory eye examination (74.4% vs. 39.0%; adjusted risk ratio = 1.85; 95% CI: 1.51-2.28; P < 0.001; data not published). 12,13 These 2 studies identified successful strategies to affordably and effectively screen for treatable eye disease in vulnerable, underserved populations in urban settings. Despite this progress, substantial challenges remain to reduce the burden of vision-threatening conditions in these at-risk populations.…”

“…The PTGDF found that patient navigators and social workers improved timely attendance at the first follow-up after the confirmatory eye examination (74.4% vs. 39.0%; adjusted risk ratio=1.85; 95% CI: 1.51-2.28; P <0.001; data not published) 12,13…”

A Randomized Trial to Improve Adherence to Follow-up Eye Examinations Among People With Glaucoma

“…Barriers to nonadherence include health care costs, lack of transportation, and emotional distress (7,8). These barriers most often affect people of color, who have lower attendance rates at follow-up eye care appointments than White patients (9)(10)(11).…”