Programming Connection

Patient Navigation 

CATIE

2017

A recent scoping review1 has described the factors that impact the success of health navigation programs that link primary care (community health centres, family health teams, etc.) with community-based health and social services. The review identified 11 factors that can impact the success of health navigation programs:

  1. client characteristics
  2. navigator recruitment and training
  3. navigator role clarity
  4. clear operational processes
  5. time and resources
  6. partnerships
  7. community services
  8. communication
  9. client uptake
  10. valuing navigators
  11. evaluation

What is navigation?

In navigation programs, clients are paired with a service provider—sometimes a nurse, case manager, or peer—whose job is to support and guide clients through the healthcare system until they can manage it themselves. The review’s authors describe the roles of navigators as:

  1. facilitating access to health-related programs and services
  2. promoting and facilitating continuity of care
  3. identifying and removing barriers to care
  4. ensuring effective and efficient use of the healthcare system by clients, families, and providers

Methods

Study authors reviewed the research-based evidence related to health navigation published between January 1990 and June 2013. Articles were eligible for inclusion if they contained information about navigators or navigation programs in primary care settings that linked clients to community-based health and social services.

There were 34 articles included in the review:

  • 29 from the United States
  • two from Canada
  • two from the United Kingdom
  • one from Australia

What factors impact the success of health navigation programs in primary care?

The scoping review identified 11 factors that impact the success of health navigation programs in primary care settings:

  1. Client characteristics: Agencies should consider the complexity of client needs, language and geographic barriers, and the ability of the agency to provide culturally appropriate services when designing a navigation program.
  2. Navigator recruitment and training: Agencies should consider encouraging the growth and development of navigators, training on problem solving for complex cases, fostering collaboration among navigators, and orienting navigators to the specific needs of their clients.
  3. Role clarity: Agencies should set clear boundaries for navigators to ensure they understand their role.
  4. Clear operational processes: Agencies should develop processes, policies, and procedures that support navigation; use consensus decision-making processes; provide clinical supervision; communicate regularly with partners; and identify mechanisms to address scheduling and referral challenges.
  5. Time and resources: Agencies should provide for adequate human resources; financial resources; physical resources such as space for navigators to work; and technological resources such as electronic health record systems.
  6. Partnerships: Agencies should encourage commitment from all staff involved, and develop strong relationships with external partners using a community charter, a steering committee, and a communication strategy that includes a way to address power imbalances and other conflicts.
  7. Community services: Agencies should consider whether there are sufficient resources in the community where clients can be referred.
  8. Communication: Agencies should encourage attendance at staff meetings, share client updates through the electronic health record, and involve physicians in regular meetings.
  9. Client uptake: Agencies should get buy-in for the navigation program from clients, use diverse strategies to recruit to the program, and address any potential stigmas that may exist.
  10. Valuing navigators: Agencies should demonstrate to navigators they are valued by facilitating opportunities for them to be recognized and heard.
  11. Evaluation: Agencies should develop an evaluation plan, consider participatory research processes, focus on program processes, use pre-identified indicators, and address potential problems with lack of access to data, monitoring health changes over time, and attribution of outcomes to the navigation program.

Navigation already being used to support people living with HIV

Research evidence also exists to support the use of navigation programs specifically for people living with HIV. Linkage to care rates among clients of navigation programs significantly increased after program implementation.2,3 There is also evidence to show that navigators significantly improve retention rates of HIV-positive clients in care.2–5 Critically, research shows that working with a navigator can significantly improve treatment outcomes among people living with HIV, including increased CD4 counts and decreased viral loads.2,3

Navigation programs are already used in Canada to support people living with HIV to achieve optimal health and wellness outcomes, including programs in Vancouver, Kamloops, and Regina. Canadian guidelines that will support the strengthening of existing programs and the development of new peer health navigation programs for people living with HIV will be published in 2017.

References

  1. Valaitis RK, Carter N, Lam A, et al. Implementation and maintenance of patient navigation programs linking primary care with community-based health and social services: a scoping literature review. BMC Health Services Research. 2017 Dec;17(1):116. Available from: http://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-017-2046-1
  2. Bradford JB, Coleman S, Cunningham W. HIV System Navigation: An emerging model to improve HIV care access. AIDS Patient Care and STDs. 2007 Jun;21(s1):S-49–58.
  3. Farrisi D, Dietz N. Patient navigation is a client-centered approach that helps to engage people in HIV care. HIV Clinician. 2013;25(1):1–3.
  4. Zaller ND, Holmes L, Dyl AC, et al. Linkage to treatment and supportive services among HIV-positive ex-offenders in Project Bridge. Journal of Health Care for the Poor and Underserved. 2008 May;19(2):522–31.
  5. Willis S, Castel AD, Ahmed T, et al. Linkage, engagement, and viral suppression rates among HIV-infected persons receiving care at medical case management programs in Washington D.C. Journal of Acquired Immune Deficiency Syndromes. 2013 Nov;64(Supplement 1):S33–41.