title: A randomized, controlled trial to test the effectiveness of a glaucoma patient navigator to improve appointment adherence.
abstract: OBJECTIVE
  Patients 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.
  
  
  METHODS
  Patients 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.
  
  
  RESULTS
  A 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).
  
  
  CONCLUSIONS
  Help 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.
authors.affiliation: Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Hark
authors.affiliation: Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA.
authors.forename: Deiana M
authors.initials: DM
authors.lastname: Johnson
authors.affiliation: Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA.
authors.forename: Giuliana
authors.initials: G
authors.lastname: Berardi
authors.affiliation: Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA.
authors.forename: Neal S
authors.initials: NS
authors.lastname: Patel
authors.affiliation: Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA.
authors.forename: Lichuan
authors.initials: L
authors.lastname: Zeng
authors.affiliation: Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA.
authors.forename: Yang
authors.initials: Y
authors.lastname: Dai
authors.affiliation: Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA.
authors.forename: Eileen L
authors.initials: EL
authors.lastname: Mayro
authors.affiliation: Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Waisbourd
authors.affiliation: Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA.
authors.forename: L Jay
authors.initials: LJ
authors.lastname: Katz
keywords: access to eye care; appointment adherence; glaucoma; patient navigator; underserved population