Abstract
IntroductionAppointment nonadherence is common among people with glaucoma, making it difficult for eye care providers to monitor glaucoma progression. Our objective was to determine whether the use of patient navigators, in conjunction with social worker support, could increase adherence to recommended follow-up eye appointments.MethodsA randomized, controlled trial evaluated the effectiveness of an intervention that used patient navigators and social workers to improve patient adherence to follow-up eye care compared with usual care. Participants with glaucoma and other eye diseases (N = 344) were identified at primary care clinics in community settings through telemedicine screening of imaging and then randomized to enhanced intervention (EI) or usual care (UC). Data on participants’ visits with local ophthalmologists were collected for up to 3 years from randomization. Groups were compared for timely attendance at the first visit with the local ophthalmologist and adherence to recommended follow-up visits.ResultsTimely attendance at the first visit was higher for EI than UC (74.4% vs 39.0%; average relative risk [aRR] = 1.85; 95% CI, 1.51–2.28; P < .001). Rates of adherence to recommended annual follow-up during year 1 were 18.6% in the EI group and 8.1% in the usual care group (aRR = 2.08; 95% CI, 1.14–3.76; P = .02). The aRR across years 2 and 3 was 3.92 (95% CI, 1.24–12.43; P = .02).ConclusionAn intervention using patient navigators and social workers doubled the rate of adherence to annual recommended follow-up eye care compared with usual care in community settings, and was effective at increasing connections with local ophthalmologists. Interventions to further improve long-term adherence are needed.
Highlights
Appointment nonadherence is common among people with glaucoma, making it difficult for eye care providers to monitor glaucoma progression
A randomized, controlled trial evaluated the effectiveness of an intervention that used patient navigators and social workers to improve patient adherence to follow-up eye care compared with usual care
Timely attendance at the first visit was higher for enhanced intervention (EI) than usual care (UC) (74.4% vs 39.0%; average relative risk [Adjusted estimates of the relative risk (aRR)] = 1.85; 95% CI, 1.51–2.28; P < .001)
Summary
Appointment nonadherence is common among people with glaucoma, making it difficult for eye care providers to monitor glaucoma progression. Glaucoma is a chronic eye disease resulting in visual field defects and progressive vision loss and is the leading cause of irreversible blindness worldwide [1]. All text from this work may be reprinted freely Use of these materials should be properly cited. 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]
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