Translating the Patient Navigator Approach to Meet the Needs of Primary Care

The Journal of the American Board of Family Medicine

Jeanne M. Ferrante²  Jesse C. Crosson²  Deborah J. Cohen¹ 

[1] Department of Family Medicine, Oregon Health & Science University (DJC);Department of Family Medicine and Community Health, University of Medicine and Dentistry of New Jersey—Robert Wood Johnson Medical School, New Brunswick (JMF, JCC)

关键词: Patient Navigation;    Patient-Centered Care;    Medical Home;    Qualitative Research;    Practice-Based Research;    Delivery of Health Care;   

DOI  :  10.3122/jabfm.2010.06.100085

学科分类：过敏症与临床免疫学

来源: The American Board of Family Medicine

【 摘 要 】

Background: Helping patients navigate the complex and fragmented US health care system and coordinating their care are central to the patient-centered medical home. We evaluated the pilot use of a patient navigator (PN), someone who helps patients use the health care system effectively and efficiently, in primary care practices.

Methods: This study was a cross-case comparative analysis of 4 community practices that implemented patient navigation. Project meeting notes, PN activity logs and debriefings, physician interviews, and patient/family member interviews were analyzed using a grounded approach.

Results: Seventy-five mostly female, elderly patients received navigation services from a social worker. The PN typically helped patients obtain social services and navigate health coverage and complex referrals. Availability of workspace for PN, interaction with practice members, and processes used for selecting and referring patients affected PN collaboration with and integration into practices. Patients found PN services very helpful, and physicians viewed the PN as someone carrying out new tasks that the practice was not previously doing.

Conclusions: Patient navigation in community primary care practices is useful for patients who have complex needs. Integrating such services into primary care settings will require new practice and payment models to realize the full potential of integrated patient navigation services in this setting.

• Patient Navigation
• Patient-Centered Care
• Medical Home
• Qualitative Research
• Practice-Based Research
• Delivery of Health Care

There is widespread endorsement of the patient-centered medical home (PCMH) as a new model of care to reform the US health care system into one that is more patient centered, accessible, effective, safer, and efficient.^1,2 Currently, the US health care system is complex, confusing, and fragmented,³ and helping patients better navigate this system and coordinating the care they receive are central to the PCMH.⁴ However, how best to accomplish these functions in primary care practice remains unclear.⁵ Although many PCMH demonstration projects are focusing on information technology (IT)⁶ to help primary care physicians better track and monitor patients, less effort has been directed at helping patients navigate the health care system to ensure that they receive the care they need at the right time. Ineffective navigation of the health care system by patients may lead to poorer outcomes and inefficiencies because of delayed care, failure to receive proper care or treatments, or care being received in more expensive locations (ie, emergency rooms).⁷

Patient navigation may be defined as the process of helping patients to effectively and efficiently use the health care system. Sofaer⁷ describes 4 major challenges patients face when navigating our complex system: (1) choosing, understanding, and using health coverage or applying for assistance when uninsured; (2) choosing, using, and understanding different types of health providers and services; (3) making treatment decisions; and (4) managing care received by multiple providers. Although primary care practices are often expected to assist patients in meeting these challenges, the majority of practices cannot assume this role effectively because of perceived time, personnel, and reimbursement constraints. Efforts to address patient navigation challenges have been successfully implemented in other organizations (eg, cancer centers), and these programs potentially may be translated to community primary care settings.

Cancer care programs have widely implemented the use of nurses, social workers, and trained peer counselors or lay persons as patient navigators (PNs) to provide education, psychosocial support, and assistance to patients when accessing and using needed services.^8,9 The use of PNs in these settings has been successful in increasing rates of cancer screening and adherence to follow-up care after an abnormal screening while increasing patient satisfaction and decreasing anxiety.^10–14 Similarly, health plans and integrated delivery systems have used care managers or care coordinators to focus on high-risk, high-cost patients who have a single disease (eg, diabetes or asthma) to ensure they receive services they need.⁵ These PN and care manager programs usually focus on patients who have a single disease; additionally, these programs use PNs in cancer settings or care managers who are external to practices. No one has described the use of a PN in primary care settings for patients who have a variety of health problems.

The use of a dedicated person to assist patients in meeting the navigation challenges described above by Sofaer,⁷ is a potential strategy to help achieve collaborative, team-based care in the PCMH, but little is known about the feasibility of this strategy in community-based primary care settings. We present the results of a qualitative evaluation of the implementation and use of a pilot PN program in 4 community practices and describe the barriers and facilitators to integrating this new role in these settings. Goals of this qualitative evaluation were (1) to elicit insights into the process of establishing PN services; (2) to understand the barriers and facilitators to PN use in the primary care setting; and (3) to gain an in-depth understanding of patient and physician experiences with PN services.

【 授权许可】

Unknown   

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