Feasibility of Chronic Disease Patient Navigation in an Urban Primary Care Practice

Abstract

The purpose of this study was to evaluate the feasibility of incorporating chronic disease navigation using lay health care workers trained in motivational interviewing (MI) into an existing mammography navigation program. Primary-care patient navigators implemented MI-based telephone conversations around mammography, smoking, depression, and obesity. We conducted a small-scale demonstration, using mixed methods to assess patient outcomes and provider satisfaction. One hundred nine patients participated. Ninety-four percent scheduled and 73% completed a mammography appointment. Seventy-one percent agreed to schedule a primary care appointment and 54% completed that appointment. Patients and providers responded positively. Incorporating telephone-based chronic disease navigation supported by MI into existing disease-specific navigation is efficacious and acceptable to those enrolled.

Patient Navigators Connecting Patients to Community Resources to Improve Diabetes Outcomes

“…14,15,28 tk; 3The results of our study corroborate previous findings and demonstrate that glycemic control and patient self-efficacy levels improved among patients after participating in telephone-based patient navigation. The observed effects of a 0.6% change in HbA 1c were comparable with those reported in meta-analyses and systematic reviews of pharmaceutical agents for treating diabetes and is considered to be clinically significant.…”

Feasibility of Patient Navigation in Resident Primary Care Practice

“…We found that 34% of the navigated women could not be reached by phone. Prior studies have demonstrated similar challenges with urban safety-net populations (Battaglia et al, 2012b;Lasser et al, 2009;Myers et al, 2008;Phillips et al, 2010). Alternative protocols that use in-person outreach efforts, such as home visits and community educational sessions, may have more success (Percac-Lima et al, 2011) but are more resource-intensive.…”

“…We evaluated the following feasibility metrics: (1) practicality (ability to carry out the intervention), (2) effectiveness (ability of the intervention to increase mammography screening rates), and (3) acceptability (resident satisfaction with the intervention) (Battaglia et al, 2012b;Bowen et al, 2009). The BMC institutional review board approved this study.…”

“…The measures were derived from 8 general areas of focus of feasibility studies proposed by Bowen et al and used in a prior study (Battaglia et al, 2012b;Bowen et al, 2009).…”

“…Patient navigation involves identifying and addressing individual-level barriers to improve the delivery of timely care as well as tracking patients over time until completion of a defined set of care activities (Wells et al, 2008). Navigator activities may include assisting in completion of medical paperwork; scheduling, confirming, and rescheduling appointments; arranging for transportation to and childcare during scheduled appointments; facilitating patient-provider communications; arranging for interpreter services; arranging for financial support; and providing psychosocial support (Battaglia et al, 2012a(Battaglia et al, , , 2012bBrownstein et al, 2011;Ell et al, 2007;Freund et al 2008;Jandorf et al, 2005;Nash et al, 2006;Nguyen et al, 2006;Wells et al, 2008). Patient navigators are usually culturally congruent lay health workers trained to act as liaisons between community members and health care providers (Witmer et al, 1995).…”