Evolution of a health navigator model of care within a primary care setting: a case study
Fiona Doolan-Noble A D , Danielle Smith B , Robin Gauld A , Debra L. Waters A , Anthony Cooke C and Helen Reriti BA Department of Preventive and Social Medicine, University of Otago, PO Box 913, Dunedin 9054, New Zealand. Email: robin.gauld@otago.ac.nz; debra.waters@otago.ac.nz
B West Coast Primary Health Organisation, PO Box 544, Greymouth, New Zealand. Email: danielle.smith@westcoastpho.org.nz; helen.reriti@westcoastpho.org.nz
C PHOcus on Health, 216 Bluff Rd, Pokeno 2471, New Zealand. Email: anthony.cooke@phocusonhealth.co.nz
D Corresponding author. Email: fiona.doolan-noble@otago.ac.nz
Australian Health Review 37(4) 523-528 https://doi.org/10.1071/AH12038
Submitted: 18 December 2012 Accepted: 12 June 2013 Published: 17 July 2013
Abstract
Objective. Patient navigation originated as an approach for reducing disparities in cancer care and consequent health outcomes. Over time navigator models have evolved and been used to address various health issues in differing contexts. This case study outlines the evolution, purpose and effects of a lay-led health navigator model in a deprived, sparsely populated, New Zealand rural setting, where primary care services are frequently understaffed and routinely overstretched.
Methods. Routinely collected service utilisation data, survey results and health navigator interview data were utilised to illustrate the client group the service works with, why primary care refer to the service, as well as lessons learned from implementation to ongoing service provision.
Results. Those referred to the navigator service generally represented the most vulnerable in the community. Survey respondents, overall, were highly satisfied with the service. Navigators identified barriers and facilitators to implementation, as well as ongoing obstacles and enablers to service provision.
Conclusions. This lay-led navigator service provided support to a group of unwell individuals, with few resources and multiple barriers to negotiate, and has effectively engaged with health and social care services, while overcoming various barriers and obstacles to its establishment and ongoing operation.
What is known about the topic? Patient navigation models of care were first employed in the 1990s, as a strategy to increase the uptake of cancer screening among disadvantaged women. They have since expanded across the cancer care continuum, but despite favourable findings, information regarding their potential in other settings is limited.
What does this paper add? This paper provides a perspective on lay-led navigation services within a rural New Zealand primary care setting. The views of primary care professionals regarding the role and value of the service are provide, as is a summary of the key lessons learnt over the implementation, establishment and ongoing service delivery phases of the programme.
What are the implications for practitioners? This case study proposes that lay-led navigation services can provide practical support to primary care; assisting it to meet the needs of patients living with multiple chronic conditions and social challenges.
References
[1] Freeman HP. Patient navigation: a community based strategy to reduce cancer disparities. J Urban Health 2006; 83 139–41.| Patient navigation: a community based strategy to reduce cancer disparities.Crossref | GoogleScholarGoogle Scholar | 16736361PubMed |
[2] Manderson B, Mcmurray J, Piraino E, Stolee P. Navigation roles support chronically older adults through healthcare transitions: a systematic review of the literature. Health Soc Care Community 2012; 20 113–27.
| Navigation roles support chronically older adults through healthcare transitions: a systematic review of the literature.Crossref | GoogleScholarGoogle Scholar | 21995806PubMed |
[3] Dohan D, Schrag D. Using navigators to improve care of underserved patients. Current practices and approaches. Cancer 2005; 104 848–55.
| Using navigators to improve care of underserved patients. Current practices and approaches.Crossref | GoogleScholarGoogle Scholar | 16010658PubMed |
[4] The Centre for Health Affairs. The emerging field of patient navigation: a golden opportunity to improve healthcare. Cleveland: The Centre for Health Affairs; 2012.
[5] Freund K, Paskett E, Corle D, Snyder F, Calhoun E, Dudley D, et al Patient navigation and timeliness of diagnostic evaluation: results from the patient navigation research programme. Cancer Epidemiol Biomarkers Prev 2011; 20 PL06-02
| Patient navigation and timeliness of diagnostic evaluation: results from the patient navigation research programme.Crossref | GoogleScholarGoogle Scholar |
[6] West Coast District Health Board. Te Kaupapa Hauora Maori. Maori Health Plan 2012–2013. Greymouth: West Coast District Health Board; 2012.
[7] West Coast Primary Health Organisation, West Coast District Health Board. Business case, better, sooner, more convenient primary health care. Greymouth: West Coast Primary Health Organisation; 2010.
[8] West Coast District Health Board. Annual plan with statement of intent 2011–2012. Greymouth: West Coast District Health Board; 2011.
[9] Bodenheimer T, Pham H. Primary care: current problems and proposed solutions. Health Aff (Millwood) 2010; 29 799–805.
| Primary care: current problems and proposed solutions.Crossref | GoogleScholarGoogle Scholar | 20439864PubMed |
[10] Health Outcomes International. Community cancer support services pilot project evaluation. Wellington: Ministry of Health; 2011.
[11] Fiscella K, Ransom S, Jean-Pierre P, Cella D, Stein K, Bauer J, et al. Patient-reported outcome measures suitable to assessment of patient navigation. Cancer 2011; 117 3603–17.
| 21780095PubMed |
[12] Ferrante J, Cohen D, Crosson J. Translating the patient navgator approach to meet the needs of primary care. J Am Board Fam Med 2010; 23 736–44.
| Translating the patient navgator approach to meet the needs of primary care.Crossref | GoogleScholarGoogle Scholar | 21057069PubMed |
[13] Schonlau M, Fricker R, Eilliot M. Conducting research surveys via e-mail and the web. Santa Monica, CA: RAND Corporation; 2002.
[14] Mauri Ora Associates. He ritanga whakaaro: Maori experiences of health services. Auckland: Mauri Ora Associates; 2009.
[15] Ministry of Health. A portrait of health. Key results of the 2006/07 New Zealand health survey. Wellington: Ministry of Health; 2008.
[16] National Advisory Committee on Health and Disability. The social, cultural and economic determinants of health in New Zealand: action to improve health. Wellington: National Advisory Committee on Health and Disability; 1998.
[17] Fiscella K, Epstein R. So much to do, so little time: caring for the socially disadvantaged and the 15-minute visit. Arch Intern Med 2008; 168 1843–52.
| So much to do, so little time: caring for the socially disadvantaged and the 15-minute visit.Crossref | GoogleScholarGoogle Scholar | 18809810PubMed |
[18] Kavanagh J. Caring for people with chronic conditions. How technology can support an evidence-based model in order to help improve chronic care. Available at: http://kinwahlin.wordpress.com/2010/05/18/caring-for-people-with-chronic-conditions-how-technology-can-support-an-evidence-based-model-in-order-to-help-improve-chronic-care-microsoft-white-paper/ [verified 1 July 2013]
[19] National Health Committee. Meeting the needs of people with chronic conditions Hapai te whanau mo ake ake tonu. Wellington: National Advisory Committee on Health and Disability; 2007.
