Patient navigators for people with chronic disease: protocol for a systematic review and meta-analysis

Abstract

BackgroundIndividuals with chronic diseases may have difficulty optimizing their health and getting the care they need due to a combination of patient, provider, and health system level barriers. Patient navigator programs, in which trained personnel assess and assist patients in overcoming barriers to care, may improve care and outcomes for patients with chronic disease by providing an alternative approach to conventional information and support resources.MethodsThis systematic review will evaluate the evidence for patient navigator programs, compared to usual care, in patients with chronic disease. We will include RCTs, cluster RCTs, and quasi-randomized RCTs that study the effects of patient navigator programs on clinical outcomes, patient experience, and markers of adherence to care. Studies will be identified by searching MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, PsycINFO, Social Work Abstracts, and the references of included studies. Two authors will screen titles and abstracts independently. Full texts will be reviewed for relevance and data extraction will be done independently by two authors. Studies will be included if they assess patients of any age with one or more chronic diseases. Outcomes will be categorized into groups characterized by their proximity to mechanism of action of the intervention: patient-level outcomes, intermediate outcomes, and process outcomes. Descriptive data about the elements of the patient navigator intervention will also be collected for potential subgroup analyses. Risk of bias will be assessed using the Effective Practice and Organisation of Care Group (EPOC) risk of bias tool. Data will be analyzed using random effects meta-analysis (relative risk for dichotomous data and mean difference for continuous data), if appropriate.DiscussionA comprehensive review of patient navigator programs, including a summary of the elements of programs that are associated with a successful intervention, does not yet exist. This systematic review will synthesize the evidence of the effect of patient navigator interventions on clinical and patient-oriented outcomes in populations across a comprehensive set of chronic diseases.Systematic Review RegistrationPROSPERO CRD42013005857.

What is the scope of improving immigrant and ethnic minority healthcare using community navigators: A systematic scoping review

“…[ 37 ] Hispanic 70 Average age 60 12 months Type 2 diabetes Blood HbA1c level (%) Significant reduction by 1% ( P = 0.01) Perez-Escamilla R et al [ 36 ] Latino 211 ≥21 18 months Type 2 diabetes Blood HbA1c level (%) Significant group difference in reduction of HbA1c level (−0.55, P = 0.009) Prezio et al [ 31 ] Hispanic 189 18-75 12 months Type 2 diabetes Blood HbA1c level (%) Significant reduction by 0.7 % ( P = 0.02) Ursua et al [ 43 ] Filipino 39 25-75 4 months Hypertension management Blood pressure control, appointment keeping and medication adherence 27.3 % increase in number of individuals with controlled blood pressure Hurtado et al [ 4 ] African American, American Indian, Hispanic and Filipino 849 Mean age 48 3 years Cardiovascular risk factors Heart healthy knowledge, heart healthy meal, CVD risk factor behavior Heart healthy knowledge score and CVD risk factor behavior increased by 26 % and 44 % ( P < 0.001) respectively. Sanchez et al [ 41 ] Latino 96 ≥18 9 weeks Hypertension management Food habit and physical activity Significant improvement in self reported behavior Balcazar et al [ 21 ] Latino 320 NR 6 months Cardiovascular risk factors Health habits, community referrals, screening, information sharing 18 % improvement of average overall score ( P < 0.001) Spinner et al [ 40 ] Latino 435 NR 65 days Car...…”

“…Community navigators are particularly relevant for Canada [ 12 ] and the United States [ 13 ], which accommodate many immigrants [ 14 ]. Although community navigator programs were initially introduced to ease disparities in cancer care among vulnerable populations [ 15 ], the United States is now widely using community navigators to address other healthcare gaps [ 4 ]. Canadian navigation programs are still focused on cancer treatment and care, mostly among the general population, rather than specifically among the underserved immigrant group [ 6 ].…”

Patient navigators for people with chronic disease: A systematic review

“…To provide an estimate of publication bias, we divided the studies into quintiles of sample size and compared the proportion of studies reporting a positive statistically significant effect across quintiles. All work aligned with a protocol that was developed and published ahead of the review [ 35 ].…”

Patient navigators facilitating access to primary care: a scoping review

“…A new approach to improve access to primary care is patient navigation , a process where a person (navigator) engages with a patient to determine barriers to care and provides information to improve access to components of the health system, not just primary care. 12 A patient navigator has been described as a type of ‘broker’ who uses a biopsychosocial approach to provide a range of instrumental and relational functions and processes 13 14 to support patients to access primary care and directly identify providers willing to treat vulnerable people requiring care. 15 Patient navigator tasks can include educating patients about early symptoms of cancer (in preventive care) or facilitating and coordinating appointments with providers to improve access to a regular primary care provider.…”