Patient Navigator Program Tools

Summary prepared by the AETC Engagement in Care Workgroup

Description

• Demographically-related peers or lay health workers function in a complementary capacity with clinic staff to assist patients access, and engage in, medical and supportive services while working to address patients' knowledge, communication and literacy gaps, and enhance health-promoting behaviors.

Strengths

• Principles of patient navigation are rooted in community (lay) health worker and peer-based intervention strategies;
• methodology of patient navigation is well described in the non-HIV literature and has been incorporated into a number of disease prevention and management models, including those for cancer, diabetes, asthma, CVD, and maternal and child health. In the context of HIV, longitudinal data from a HRSA SPNS demonstration grant (Bradford, 2007) found improved engagement in care and viral load suppression associated with patient navigation.
• Patient navigation can be implemented by a clinic or in collaboration with community-based service organizations; can also be tailored to site-specific needs and resources.

Challenges

• Limited prospective evaluations and/or cost-benefit analyses of patient navigation for any disease, particularly related to morbidity and mortality outcomes.
• Reimbursement sources may be limited.
• Patient navigator responsibilities that overlap with other clinic staff may create confusion and billing difficulties.
• Lack of standardized training programs for navigators.

Resources Required

• Senior clinic leadership support.
• Full integration of patient navigation in to outcomes planning and strategies.
• Development of navigator training programs and mechanisms for ongoing evaluation of fidelity and outcomes.
• Coordination of staff and/or collaboration with community-based service organization to provide adequate training for patient navigators.
• Training of existing clinic staff.

Model Programs

• Fenway Health
  Phone: (617) 267-0159
  Email: [email protected]
  Contact: Steve Boswell

Evidence

• Bradford JB, Coleman S, Cunningham W. (2007). HIV System Navigation: an emerging model to improve HIV care access. AIDS Patient Care STDS. 21: 49-58.

• Lewin S., Munabi-Babigumira, S., Glenton, C., Daniels, K., Bosch-Capblanch, X., van Wyk, B.E., Odgaard-Jensen, J., Johansen, M., Aja, G.N., Zwarenstein, M., Scheel, I.B. (2010). Lay Health Workers in Primary and Community Health Care for Maternal and Child Health and the Management of Infectious Diseases. Cochrane Database of Systematic Reviews, 3, 1-85.

• Viswanathan, M., Kraschnewski, J., Nishikawa, B., Morgan, L.C., Thieda, P., Honeycutt, A., Lohr, K.N., Jonas, D. (2009). Outcomes of Community Health Worker Interventions: Evidence Report/Technology Assessment No. 181. Triangle Park, NC: RTI International University of North Carolina Evidence-based Practice Center.

Tools

• Consumer Link Project: Strategies to involve Ryan White Consumers in Linking Other PLWH into Primary Medical Care and Other Needed Services
• Organizations that CARE: A Toolkit for Employing Consumers in Ryan White CARE Act Programs
• Building Blocks to Peer Program Success: Toolkit for Developing HIV Peer Programs
• Integrating Peers into Multidisciplinary Teams: Toolkit
• Connecting to Care: Addressing Unmet Need in HIV
• An Assessment of A Pilot Peer Navigation Program Linking HIV Positive Clients of Harm Reduction Services With Ryan White Clinical Service Providers