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

Benjamin E Leiby, Sarah E Hegarty, Tingting Zhan, Jonathan S Myers, L Jay Katz, Julia A Haller, Michael Waisbourd, Christine Burns, Meskerem Divers, Jeanne Molineaux, Jeffrey Henderer, Charles Brodowski, Lisa A Hark, Benjamin E Leiby, Sarah E Hegarty, Tingting Zhan, Jonathan S Myers, L Jay Katz, Julia A Haller, Michael Waisbourd, Christine Burns, Meskerem Divers, Jeanne Molineaux, Jeffrey Henderer, Charles Brodowski, Lisa A Hark

Abstract

Introduction: Appointment 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.

Methods: 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. 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.

Results: Timely 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).

Conclusion: An 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.

Figures

Figure 1
Figure 1
Flow chart describing the Philadelphia Telemedicine Glaucoma Detection and Follow-up Study, indicating participant inclusion, exclusion, and randomization to the usual care group or enhanced intervention group.
Figure 2
Figure 2
Adherence to recommended follow-up schedule over time by intervention group. Visit 3 was the initial visit with the community ophthalmologist. Timely adherence to Visit 3 was defined as attendance within 12 months of randomization. Annual adherence in Years 1–3 was defined as having attended all recommended follow-up visits within 13 months based on the recommended follow-up at the visit closest to the beginning of the year.

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Source: PubMed

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