ObjectivePatient navigators are a promising mechanism to link patients with primary care. While navigators have been used in population health promotion and prevention programmes, their impact on access to primary care is not clear. The aim of this scoping review was to examine the use of patient navigators to facilitate access to primary care and how they were defined and described, their components and the extent to which they were patient centred.Setting and participantsWe used the Arksey and O’Malley scoping review method. Searches were conducted in MEDLINE, Embase, ProQuest Medical, other key databases and grey literature for studies reported in English from January 2000 to April 2016. We defined a patient navigator as a person or process creating a connection or link between a person needing primary care and a primary care provider. Our target population was people without a regular source of, affiliation or connection with primary care. Studies were included if they reported on participants who were connected to primary care by patient navigation and attended or made an appointment with a primary care provider. Data analysis involved descriptive numerical summaries and content analysis.ResultsTwenty studies were included in the final scoping review. Most studies referred to ‘patient navigator’ or ‘navigation’ as the mechanism of connection to primary care. As such, we grouped the components according to Freeman’s nine-principle framework of patient navigation. Seventeen studies included elements of patient-centred care: informed and involved patient, receptive and responsive health professionals and a coordinated, supportive healthcare environment.ConclusionsPatient navigators may assist to connect people requiring primary care to appropriate providers and extend the concept of patient-centred care across different healthcare settings. Navigation requires further study to determine impact and cost-effectiveness and explore the experience of patients and their families.

ObjectivesWe aimed to identify the core elements of centredness in healthcare literature. Our overall research question is: How has centredness been represented within the health literature published between 1990 and 2019?MethodsA scoping review across five databases (Medline (Ovid), PsycINFO, CINAHL, Embase (Ovid) and Scopus; August 2019) to identify all peer-reviewed literature published since 1990 that focused on the concept of centredness in any healthcare discipline or setting. Screening occurred in duplicate by a multidisciplinary, multinational team. The team met regularly to iteratively develop and refine a coding template that was used in analysis and discuss the interpretations of centredness reported in the literature.ResultsA total of 23 006 title and abstracts, and 499 full-text articles were screened. A total of 159 articles were included in the review. Most articles were from the USA, and nursing was the disciplinary perspective most represented. We identified nine elements of centredness: Sharing power; Sharing responsibility; Therapeutic relationship/bond/alliance; Patient as a person; Biopsychosocial; Provider as a person; Co-ordinated care; Access; Continuity of care. There was little variation in the concept of centredness no matter the preceding word (eg, patient-/person-/client-), healthcare setting or disciplinary lens. Improving health outcomes was the most common justification for pursuing centredness as a concept, and respect was the predominant driving value of the research efforts. The patient perspective was rarely included in the papers (15% of papers).ConclusionsCentredness is consistently conceptualised, regardless of the preceding word, disciplinary lens or nation of origin. Further research should focus on centring the patient perspective and prioritise research that considers more diverse cultural perspectives.

Aims and objectives To explore the healthcare professionals (HCP) experience of providing care coordination to people living with multimorbidity. Background There is increasing interest in improving care of people living with multimorbidity who need care coordination to help manage their health. Little is known about the experiences of HCP working with people living with multimorbidity. Design Phenomenological approach to understanding the experiences of HCP. Methods We interviewed 18 HCP, including 11 registered nurses, working in care coordination in Melbourne, Australia. We used interpretative phenomenological analysis to identify themes from descriptions of providing care, identifying and responding to a person’s needs, and the barriers and facilitators to providing person‐centred care. Results We identified four themes as follows: (a) Challenge of focusing on the person; (b) “Hear their story,” listening to and giving time to clients to tell their story; (c) Strategies for engagement in the programme; and, (d) “See the bigger picture,” looking beyond the disease to the needs of a person. Our results are reported using COREQ. Conclusions The HCP experienced challenges to a traditional approach to care when focusing on the person. They described providing care that was person‐centred, and acknowledged that optimal, guideline‐oriented care might not be achieved. They took the necessary time to hear the story and see the context of the person’s life, to help the person manage their health. Relevance to clinical practice For registered nurses in care coordination programmes, focusing on the client may challenge traditional approaches to care. Providing care involves developing a relationship with the client to optimise health outcomes. Experienced registered nurses appear to use skills in reflective practice and accept the parameters of care to improve the client’s health and well‐being.

This paper reports on two studies that used qualitative thematic and quantitative linguistic analysis, respectively, to assess the content and language of the largest ever sample of graded research impact case studies, from the UK Research Excellence Framework 2014 (REF). The paper provides the first empirical evidence across disciplinary main panels of statistically significant linguistic differences between high-versus low-scoring case studies, suggesting that implicit rules linked to written style may have contributed to scores alongside the published criteria on the significance, reach and attribution of impact. High-scoring case studies were more likely to provide specific and high-magnitude articulations of significance and reach than low-scoring cases. High-scoring case studies contained attributional phrases which were more likely to attribute research and/or pathways to impact, and they were written more coherently (containing more explicit causal connections between ideas and more logical connectives) than low-scoring cases. High-scoring case studies appear to have conformed to a distinctive new genre of writing, which was clear and direct, and often simplified in its representation of causality between research and impact, and less likely to contain expressions of uncertainty than typically associated with academic writing. Highscoring case studies in two Main Panels were significantly easier to read than low-scoring cases on the Flesch Reading Ease measure, although both high-scoring and low-scoring cases tended to be of "graduate" reading difficulty. The findings of our work enable impact case study authors to better understand the genre and make content and language choices that communicate their impact as effectively as possible. While directly relevant to the assessment of impact in the UK's Research Excellence Framework, the work also provides insights of relevance to institutions internationally who are designing evaluation frameworks for research impact.