Patient Navigators Improve In-Office Eye Exam Adherence After Community Eye Screenings in a Randomized Clinical Trial: NYC-SIGHT Study

Abstract

Purpose

To assess the effectiveness and cost of patient navigators in improving adherence to an initial in-office eye exam following community-based eye health screenings and referral to ophthalmology among underserved populations.

Design

5-year prospective, cluster-randomized clinical trial.

Participants

Eligible individuals aged 40 years and older were recruited from affordable housing developments and senior centers in Upper Manhattan.

Methods

Demographics, social determinants of health, clinical characteristics, and access to eye care were collected. Eye health screenings included visual acuity, intraocular pressure, and fundus photography. Those diagnosed with glaucoma, suspected glaucoma, retinal abnormalities, cataracts, or other ocular conditions were referred for in-office eye exams, with initial appointments scheduled by study staff. Navigator Intervention participants received appointment scheduling support for 10 months, Usual Care participants did not receive navigator assistance. T tests, chi-square tests and multivariate stepwise logistic regression analyzed factors associated with adherence. Cost-effectiveness analysis was conducted alongside the study.

Main Outcome Measures

Adherence to the initial in-office eye exam for those referred to ophthalmology.

Results

Of 468 referred participants, 47% (n = 220/468) attended the initial in-office eye exam. Adherence rates: Navigator Intervention (51.8%) versus Usual Care (38.1%). Of those who attended the in-office eye exam, mean age: 70.2 ± 11.3 years; 65.5% female; 46.8% African American, 47.3% Hispanic. Participants in the Navigator Intervention group had higher odds of adhering to the initial in-office eye exam compared to those receiving Usual Care (OR = 1.529; 95% CI (1.023, 2.285)). Participants who spoke English as their primary language also had higher odds of adhering to the initial eye exam (OR = 1.815; 95% CI (1.211, 2721)). Cost per participant in the Navigator Intervention group who attended the in-office eye exam: $24.25 vs. $33.03 per Usual Care participant.

Conclusions

Patient navigators improved adherence to in-office eye exams following community-based eye health screenings and referral to ophthalmology among an underserved population. The Navigator Intervention resulted in cost savings with an incremental cost-effectiveness difference of $8.78 less per participant randomized to the Navigator Intervention group.