A Randomized, Controlled Trial to Test the Effectiveness of a Glaucoma Patient Navigator to Improve Appointment Adherence

1. Pokhara University
School of Health and Allied Sciences
A Randomized, Controlled Trial to Test
the Effectiveness of a Glaucoma Patient
Navigator to Improve Appointment
Adherence
Presented By : Deepa kumari karn
Seminar 3nd , M Pharm (C.P), 1st Sem

2. Pokhara University
School of Health and Allied Sciences
Table of Content
• Introduction
• Research Question
• Literature Review
• Objective
– General Objective
– Specific Objective
• Rational of Study

3. Pokhara University
School of Health and Allied Sciences
• Methods
– Study design
– Sample size
• Results

4. Pokhara University
School of Health and Allied Sciences
• Methods
– Study design
– Participants
– Sample size
• Results
– Efficacy assessment
– Statistical Analysis
• Discussion
• Conclusion
• References
5/29/2017 4

5. Pokhara University
School of Health and Allied Sciences
Introduction
• Glaucoma is a progressive neurodegenerative
disorder that affects the optic nerve and the inner
layers of the retina
• Appropriate treatment and follow-up eye care are
crucial in preventing vision loss due to glaucoma
• Various research suggested that there are various
factors that is associated with the poor follow up
adherence among those people diagnosed with
glaucoma who were prescribed intraocular pressure-
lowering eye drops

6. Pokhara University
School of Health and Allied Sciences
• A patient navigator is a member of a health-care
team who helps patients “navigate” the health-care
system and get timely care
• To determine the impact of a patient navigator on
glaucoma eye care follow-up adherence, the
researcher initiated a 1-year prospective,
randomized, controlled trial in an urban community
setting versus office-based setting

7. Pokhara University
School of Health and Allied Sciences
Research Question
• What is the impact of a patient navigator on
glaucoma eye care follow-up adherence, in 1-year
prospective, randomized, controlled trial?

8. Pokhara University
School of Health and Allied Sciences
Literature Review
• The patient navigator concept was first introduced in
the 1990s by Dr Harold Freeman to help females
obtain breast cancer screening
• Patient navigation programs have been shown in
several randomized, controlled trials to improve
appointment adherence, initiation of treatment, and
patient’s quality of life

9. Pokhara University
School of Health and Allied Sciences
• Patient navigators have been utilized in a variety of
medical fields with the navigators serving to help
patients schedule doctor’s appointments, determine
insurance requirements, arrange transportation,
make appointment reminder calls, and accompany
patients to their appointments
• There was limited data on the use of a patient
navigator in an ophthalmic patient population and its
efficacy in improving follow-up adherence and
preventing vision loss, particularly among patients
diagnosed with glaucomatous diseases

10. Pokhara University
School of Health and Allied Sciences
Figure: Role of the Patient Navigator

11. Pokhara University
School of Health and Allied Sciences
Objective
• General Objective
– To determine the impact of a patient navigator on
glaucoma eye care follow-up adherence in an urban
community setting versus office-based setting
• Specific Objective
– Assessment of the patient for the eligibility for the
inclusion for the research
– To evaluate how community- and office-based
interventions affected disease progression by assessing
changes in clinical diagnoses

12. Pokhara University
School of Health and Allied Sciences
– Collection of the patient’s demographic and clinical
characteristics
– Assessment of medication adherence, and a complete eye
examination

13. Pokhara University
School of Health and Allied Sciences
Rational of Study
• There was limited data on the use of a patient
navigator in an ophthalmic patient population and its
efficacy in improving follow-up adherence and
preventing vision loss, particularly among patients
diagnosed with glaucomatous diseases

14. Pokhara University
School of Health and Allied Sciences
Methods
• Study Design:-
– This study was a randomized, controlled trial where
subjects were equally randomized into one of three groups
for a 1-year period
– Approved by the Institutional Review Board of Wills Eye
Hospital and conducted in accordance to the Declaration
of Helsinki
– Subjects were equally randomized into one of three groups
for a 1-year period

15. Pokhara University
School of Health and Allied Sciences
• 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
• Group 3 (G3) received follow-up eye care in an office-
based setting without a patient navigator

16. Pokhara University
School of Health and Allied Sciences
• Sample size

17. Pokhara University
School of Health and Allied Sciences
Results
• Effectiveness Assessment
Table : Recommended follow-up visits by diagnosis and treatment

18. Pokhara University
School of Health and Allied Sciences
Table : Patient’s demographic and clinical characteristics (n=155 patients)

19. Pokhara University
School of Health and Allied Sciences
• Statistical Analysis
Table : Factors associated with appointment adherence

20. Pokhara University
School of Health and Allied Sciences
• The appointment adherence rates were compared
among the three groups using chi-square test at a
significance level of 0.05

21. Pokhara University
School of Health and Allied Sciences

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School of Health and Allied Sciences

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School of Health and Allied Sciences

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School of Health and Allied Sciences

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School of Health and Allied Sciences

26. Pokhara University
School of Health and Allied Sciences
References
• Hark AL, Johnson MD, Berardi G, Patel S N, Zeng L,
Dai Y, Mayro LE, Waisbourd M and Katz JL (2016) A
Randomized, Controlled Trial to Test the
Effectiveness of a Glaucoma Patient Navigator to
Improve Appointment Adherence, Dovepress Journal
10, 1739–1748.
• Freeman HP (2012) The origin, evolution, and
principles of patient navigation, Cancer Epidemiol
Biomarkers Prev 21(10),1614–1617.