Patient navigators for people with chronic disease: A systematic review

Abstract

BackgroundPeople with chronic diseases experience barriers to managing their diseases and accessing available health services. Patient navigator programs are increasingly being used to help people with chronic diseases navigate and access health services.ObjectiveThe objective of this review was to summarize the evidence for patient navigator programs in people with a broad range of chronic diseases, compared to usual care.MethodsWe searched MEDLINE, EMBASE, CENTRAL, CINAHL, PsycINFO, and Social Work Abstracts from inception to August 23, 2017. We also searched the reference lists of included articles. We included original reports of randomized controlled trials of patient navigator programs compared to usual care for adult and pediatric patients with any one of a defined set of chronic diseases.ResultsFrom a total of 14,672 abstracts, 67 unique studies fit our inclusion criteria. Of these, 44 were in cancer, 8 in diabetes, 7 in HIV/AIDS, 4 in cardiovascular disease, 2 in chronic kidney disease, 1 in dementia and 1 in patients with more than one condition. Program characteristics varied considerably. Primary outcomes were most commonly process measures, and 45 of 67 studies reported a statistically significant improvement in the primary outcome.ConclusionOur findings indicate that patient navigator programs improve processes of care, although few studies assessed patient experience, clinical outcomes or costs. The inability to definitively outline successful components remains a key uncertainty in the use of patient navigator programs across chronic diseases. Given the increasing popularity of patient navigators, future studies should use a consistent definition for patient navigation and determine which elements of this intervention are most likely to lead to improved outcomes.Trial registrationPROSPERO #CRD42013005857

Impact of a transition program with navigator on loss to follow‐up, medication adherence, and appointment attendance in hemoglobinopathies

“…The ability of the TN to proactively reach out to vulnerable patients who have been missing important medical appointments takes into account the developmental factors and multiple life transitions occurring in emerging adulthood and may have contributed to the reengagement of the four patients in the post‐TN cohort. Similar patient navigation approaches have proven successful in other high‐risk populations . This study outlines the potential impact a TN can have on engagement in care for the hemoglobinopathy population.…”

The efficacy and cost‐effectiveness of patient navigation programs across the cancer continuum: A systematic review

“…Several systematic reviews of PN have been published and have shown that PN improves clinical outcomes for a variety of chronic diseases . Some reviews have included only certain subgroups such as the elderly with cancer or have been limited to English‐speaking patients .…”

“…11 Several systematic reviews of PN have been published and have shown that PN improves clinical outcomes for a variety of chronic diseases. 12,13 Some reviews have included only certain subgroups such as the elderly with cancer 14 or have been limited to English-speaking patients. 15 PN was shown to have early success in helping with the accrual of minorities to clinical trials by increasing awareness and access and reducing barriers to participation.…”

Fertility navigators in female oncofertility care in an academic medical center: a qualitative evaluation

“…13 (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) supportive, for example in providing information and reassurance during treatment, was patient, and clear in communication. Furthermore, they indicated that the contact with the FN was pleasant because they were personal and showed empathy.…”