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

Introduction Appointment nonadherence is common among people with glauc- oma, making it difficult for eye care providers to monitor glauc- oma 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 appoint- ments. Methods A randomized, controlled trial evaluated the effectiveness of an in- tervention that used patient navigators and social workers to im- prove patient adherence to follow-up eye care compared with usu- al 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 parti- cipants’ visits with local ophthalmologists were collected for up to 3 years from randomization. Groups were compared for timely at- tendance at the first visit with the local ophthalmologist and adher- ence 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.