1
|
Deville-Stoetzel N, Gaboury I, Berbiche D, Breton M. Profiling patterns of patient experiences of access and continuity at team-based primary healthcare clinics (Canada): a latent class analysis. Int J Equity Health 2024; 23:213. [PMID: 39420365 DOI: 10.1186/s12939-024-02300-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 10/07/2024] [Indexed: 10/19/2024] Open
Abstract
BACKGROUND Access to primary healthcare services is a core lever for reducing health inequalities. Population groups living with certain individual social characteristics are disproportionately more likely to experience barriers accessing care. This study identified profiles of access and continuity experiences of patients registered with a family physician working in team-based primary healthcare clinics and explored the associations of these profiles with individual and organizational characteristics. METHODS A cross-sectional e-survey was conducted between September 2022 and April 2023. All registered adult patients with an email address at 104 team-based primary healthcare clinics in Quebec were invited to participate. Latent class analysis was used to identify patient profiles based on nine components of access to care and continuity experiences. Multinomial logistic regression models were fit to analyze each profile's association with ten characteristics related to individual sociodemographics, perceived heath status, chronic conditions and two related to clinic area and size. RESULTS Based on 87,155 patients who reported on their experience, four profiles were identified. "Easy access and continuity" (42% of respondents) was characterized by ease in almost all access and continuity components. Three profiles were characterized by diverging access and/or continuity difficulties. "Challenging booking" (32%) was characterized by patients having to try several times to obtain an appointment at their clinic. "Challenging continuity" (9%) was characterized by patients having to repeat information that should have been in their file. "Access and continuity barriers" (16%) was characterized by difficulties with all access and continuity components. Female gender and poor perceived health significantly increased the risk of belonging to the three profiles associated with difficulties by 1.5. Being a recently arrived immigrant (p = 0.036), having less than a high school education (p = 0.002) and being registered at a large clinic (p < 0.001) were associated with experiencing booking difficulties. Having at least one chronic condition (p = 0.004) or poor perceived mental health (p = 0.048) were associated with experiencing continuity difficulties. CONCLUSIONS These results highlight individual social and health characteristics associated with increased risk of experiencing healthcare access difficulties, such as immigration status and education level and/or continuity difficulties when having a chronic condition and poor perceived mental health. Facilitating appointment booking for recently arrived immigrants and patients with low education, integrating interprofessional collaboration practices for patients with chronic conditions and improving care coordination and communication for patients with mental health needs are recommended.
Collapse
Affiliation(s)
- Nadia Deville-Stoetzel
- Department of Community Health, Université de Sherbrooke, 150 Place Charles-Le Moyne, Room 200, Longueuil CampusLongueuil, QC, J4K 0A8, Canada.
| | - Isabelle Gaboury
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Longueuil, QC, Canada
| | - Djamal Berbiche
- Department of Community Health, Université de Sherbrooke, 150 Place Charles-Le Moyne, Room 200, Longueuil CampusLongueuil, QC, J4K 0A8, Canada
| | - Mylaine Breton
- Department of Community Health, Université de Sherbrooke, 150 Place Charles-Le Moyne, Room 200, Longueuil CampusLongueuil, QC, J4K 0A8, Canada
| |
Collapse
|
2
|
Lalji R, Koh L, Francis A, Khalid R, Guha C, Johnson DW, Wong G. Patient navigator programmes for children and adolescents with chronic diseases. Cochrane Database Syst Rev 2024; 10:CD014688. [PMID: 39382077 PMCID: PMC11462635 DOI: 10.1002/14651858.cd014688.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2024]
Abstract
BACKGROUND Despite a substantial global improvement in infant and child mortality from communicable diseases since the early 1990s there is now a growing burden of chronic disease in children and adolescents worldwide, mimicking the trend seen in the adult population. Chronic diseases in children and adolescents can affect all aspects of their well-being and function with these burdens and their health-related consequences often carried into adulthood. Up to one third of disability-adjusted life years for children and adolescents globally are a result of chronic disease. This has profound implications for the broader family unit, communities, and health systems in which these children and young people reside. Models of chronic care delivery for children and adolescents with chronic disease have traditionally been adapted from adult models. There is a growing recognition that children and adolescents with chronic diseases have a unique set of healthcare needs. Their needs extend beyond disease education and management appropriate to the developmental stage of the child, to encompass psychological well-being for the entire family and a holistic care approach focusing on the social determinants of health. It is for this reason that patient navigators have been proposed as a potential intervention to help fulfil this critical healthcare gap. Patient navigators are trained medical or non-medical personnel (e.g. lay health workers, community health workers, nurses, or people with lived experience) who provide guidance for the patients (and their primary caregivers) as they move through complex (and often bewildering) medical and social systems. The navigator may deliver education, help to co-ordinate patient care, be an advocate for the patient (and their primary caregivers), or combinations of these. Patient navigators can assist people with a chronic illness (especially those who are vulnerable or from a marginalised population, or both) to better understand their diagnoses, treatment options, and available resources. As there is considerable variation in the purpose, design, and target population of patient navigator programmes, there is a need to systematically review and summarise the existing literature on the effectiveness of navigator programmes in children and young adults with chronic disease. OBJECTIVES To assess the effectiveness of patient navigator programmes in children and adolescents with chronic diseases. SEARCH METHODS We searched the Cochrane Library and Epistemonikos up to 20 January 2023 for related systematic reviews using search terms relevant to this review. We searched CENTRAL, MEDLINE, Embase, CINAHL EBSCO, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal, and ClinicalTrials.gov for primary studies. SELECTION CRITERIA We included randomised controlled trials reporting the effect of patient navigator interventions on children and adolescents (aged 18 years or younger) with any chronic disease in hospital or community settings. Two review authors independently assessed the retrieved titles and abstracts, and where necessary, the full text to identify studies that satisfied the inclusion criteria. DATA COLLECTION AND ANALYSIS Two review authors extracted data using a standard data extraction form. We used a random-effects model to perform a quantitative synthesis of the data. We used the I² statistic to measure heterogeneity amongst the studies in each analysis. We indicated summary estimates as mean differences (MD), where studies used the same scale, or standardised mean differences (SMD), where studies used different scales, with 95% confidence intervals (CI). We used subgroup and univariate meta-regression to assess reasons for between-study differences. We used the Cochrane RoB 1 tool to assess the methodological quality of the included studies. We used GRADE to assess the certainty of the evidence. MAIN RESULTS We included 17 studies (2895 randomised participants). All studies compared patient navigators with standard care. Most studies were at unclear or high risk of bias. Meta-analysis was undertaken only for those studies that had the same duration of patient navigator intervention and follow-up/reporting of outcome measures. The evidence is very uncertain about the effects of patient navigator programmes compared with standard care on self-reported quality of life of children with chronic illness (SMD 0.63, 95% CI -0.20 to 1.47; I2 = 96%; 4 studies, 671 participants; very low-certainty evidence); parent proxy-reported quality of life (SMD 0.09, 95% CI -2.21 to 2.40; I2 = 99%; 2 studies, 309 participants; very low-certainty evidence); or parents' or caregivers' quality of life (SMD -1.98, 95% CI -4.13 to 0.17; I2 = 99%; 3 studies, 757 participants; very low-certainty evidence). It is uncertain whether duration of patient navigator intervention accounts for any of the variances in the changes in quality of life. The evidence is very uncertain about the effects of patient navigator programmes compared with standard care on the number of hospital admissions (MD -0.05, 95% CI -0.34 to 0.23; I2 = 99%; 2 studies, 381 participants; very low-certainty evidence) and the number of presentations to the emergency department (MD 0.06, 95% CI -0.23 to 0.34; I2 = 98%; 2 studies, 381 participants; very low-certainty evidence). Furthermore, it is unclear whether patient navigator programmes reduce the number of missed school days as data were sparse (2 studies, 301 participants). Four studies (629 participants) reported data on resource use. However, given the variation in units of analysis used, meta-analysis was not possible (very low-certainty evidence). All studies reported cost savings or quality-adjusted life year improvement (or both) in the patient navigation arm. No studies reported on adverse events (specifically, abuse of any type against the navigator, the patient, or their family members). AUTHORS' CONCLUSIONS There is insufficient evidence at present to support the use of patient navigator programmes for children and adolescents with chronic diseases. The current evidence is based on limited data with very low-certainty evidence. Further studies are likely to significantly change these results.
Collapse
Affiliation(s)
- Rowena Lalji
- The Centre for Kidney Research, The University of Queensland, Brisbane, Australia
- Metro South Kidney and Transplant Services, Princess Alexandra Hospital, Woolloongabba, Australia
- Queensland Children and Adolescent Renal Service (QCARS), Queensland Children's Hospital, Brisbane, Australia
| | - Lee Koh
- Department of Paediatric Nephrology, Starship Children's Hospital, Auckland, New Zealand
| | - Anna Francis
- The Centre for Kidney Research, The University of Queensland, Brisbane, Australia
- Metro South Kidney and Transplant Services, Princess Alexandra Hospital, Woolloongabba, Australia
- Queensland Children and Adolescent Renal Service (QCARS), Queensland Children's Hospital, Brisbane, Australia
| | - Rabia Khalid
- School of Public Health, The University of Sydney, Sydney, Australia
| | - Chandana Guha
- School of Public Health, The University of Sydney, Sydney, Australia
| | - David W Johnson
- Metro South Kidney and Transplant Services, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Germaine Wong
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| |
Collapse
|
3
|
Wehrli S, Baumgartner MR, Dwyer AA, Landolt MA. Latent profiles and predictors of barriers to care in Swiss children and adolescents with rare diseases. J Pediatr Psychol 2024:jsae076. [PMID: 39315918 DOI: 10.1093/jpepsy/jsae076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 09/03/2024] [Accepted: 09/03/2024] [Indexed: 09/25/2024] Open
Abstract
OBJECTIVE Children and adolescents with rare diseases face significant barriers when accessing healthcare. We aimed to assess and predict these barriers and investigate associations with health-related quality of life (HRQoL). METHOD We conducted a cross-sectional survey of Swiss parents (N = 189) of children with rare diseases including the Barriers to Care Questionnaire (BCQ), containing six barriers and the Pediatric Quality of Life Inventory (PedsQL). Latent profile analysis (LPA) was used to uncover distinct classes, which were compared using chi-square tests and Mann-Whitney U tests. Relevant medical and sociodemographic class predictors were identified using Elastic Net regression, followed by regression analysis to investigate their role in predicting barriers to care and examine the effects of these classes on HRQoL. RESULTS Two distinct groups were identified, a higher barriers class (59%) and a lower barriers class (41%). In the higher barriers class, participants showed elevated scores across all subscales and specifically on pragmatics and expectations. More barriers to care were linked to a nonstable disease course (OR = 2.27, p = .002) and a diagnosis after the age of 3 months (OR = 2.17, p = .006). Individuals in the higher barriers class exhibited more psychological comorbidities (p = .044), congenital malformations/deformations/chromosomal abnormalities (p=.042), and medical misdiagnoses (p = .006). Children in the higher barriers class had significantly lower PedsQL scores compared to the lower barriers class (p <.05). CONCLUSION This study highlights the need for comprehensive assessment of barriers to pediatric care in rare diseases, offering potential entry points for targeted interventions.
Collapse
Affiliation(s)
- Susanne Wehrli
- Department of Psychosomatics and Psychiatry, University Children's Hospital, University of Zurich, Zurich, Switzerland
- Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Matthias R Baumgartner
- Division of Metabolism, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Andrew A Dwyer
- Boston College, William F. Connell School of Nursing, Boston, MA, United States
- P50 Massachusetts General Hospital-Harvard Center for Reproductive Medicine Boston, Boston, MA, United States
| | - Markus A Landolt
- Department of Psychosomatics and Psychiatry, University Children's Hospital, University of Zurich, Zurich, Switzerland
- Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland
| |
Collapse
|
4
|
Schindel D, Frick J, Gebert P, Grittner U, Letsch A, Schenk L. The effect of social care nurses on health related quality of life in patients with advanced cancer: A non-randomized, multicenter, controlled trial. Qual Life Res 2024:10.1007/s11136-024-03780-3. [PMID: 39269581 DOI: 10.1007/s11136-024-03780-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2024] [Indexed: 09/15/2024]
Affiliation(s)
- Daniel Schindel
- Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Johann Frick
- Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Pimrapat Gebert
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Anna-Louisa-Karsch-Str. 2, 10178, Berlin, Germany
| | - Ulrike Grittner
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Anna-Louisa-Karsch-Str. 2, 10178, Berlin, Germany
| | - Anne Letsch
- Department of Medicine II, Hematology and Oncology, University Hospital Schleswig-Holstein, Arnold- Heller-Straße 3, 24105, Kiel, Germany
- Charité Comprehensive Cancer Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Liane Schenk
- Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| |
Collapse
|
5
|
Howitt L, Jacob G, Zucal G, Smith J, Crocker Ellacott R, Sharkey S. Navigation Support during Transitions in Care for Persons with Complex Care Needs: A Systematic Review. Healthcare (Basel) 2024; 12:1814. [PMID: 39337156 PMCID: PMC11431248 DOI: 10.3390/healthcare12181814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 08/29/2024] [Accepted: 09/01/2024] [Indexed: 09/30/2024] Open
Abstract
Persons with complex care needs that arise due to chronic health conditions, serious illness, or social vulnerability are at increased risk of adverse health outcomes during transitions in care. To inform the development of a best practice guideline, a systematic review was conducted to examine the effect that navigation support has during transitions in care on quality of life, emergency department visits, follow-up visits, patient satisfaction, and readmission rates for persons with complex care needs. Eight databases were searched from 2016 to 2023. Studies were appraised using validated tools and data were extracted and presented narratively. The GRADE approach was used to assess the certainty of the evidence. Seventeen studies were included and the majority focused on transitions from hospital to home. Navigation support was provided for one month to one year following a transition. Results weakly indicate that providing navigation support during transitions in care may increase follow-up visits, reduce readmissions within 30 days, and increase patient satisfaction for persons with complex care needs. There were no important differences for quality of life and emergency department visits within 30 days of a transition. The certainty of the evidence was very low. Providing navigation support during transitions in care may improve outcomes for persons with complex needs; however, there remains uncertainty regarding the effectiveness of this intervention and more high-quality research is needed.
Collapse
Affiliation(s)
- Lyndsay Howitt
- Registered Nurses' Association of Ontario, 500-4211 Yonge Street, Toronto, ON M2P 2A9, Canada
| | - Greeshma Jacob
- Registered Nurses' Association of Ontario, 500-4211 Yonge Street, Toronto, ON M2P 2A9, Canada
| | - Giulia Zucal
- Registered Nurses' Association of Ontario, 500-4211 Yonge Street, Toronto, ON M2P 2A9, Canada
| | - Judy Smith
- Independent Researcher, Newmarket, ON L3Y 7T1, Canada
| | - Rhonda Crocker Ellacott
- Thunder Bay Regional Health Sciences Centre, Thunder Bay Regional Health Research Institute, 980 Oliver Road, Thunder Bay, ON P7B 6V4, Canada
| | | |
Collapse
|
6
|
Marsh M, Shah SR, Munce SEP, Perrier L, Lee TSJ, Colella TJF, Kokorelias KM. Characteristics of Existing Online Patient Navigation Interventions: Scoping Review. JMIR Med Inform 2024; 12:e50307. [PMID: 39159443 PMCID: PMC11369544 DOI: 10.2196/50307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 12/19/2023] [Accepted: 06/30/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND Patient navigation interventions (PNIs) can provide personalized support and promote appropriate coordination or continuation of health and social care services. Online PNIs have demonstrated excellent potential for improving patient knowledge, transition readiness, self-efficacy, and use of services. However, the characteristics (ie, intervention type, mode of delivery, duration, frequency, outcomes and outcome measures, underlying theories or mechanisms of change of the intervention, and impact) of existing online PNIs to support the health and social needs of individuals with illness remain unclear. OBJECTIVE This scoping review of the existing literature aims to identify the characteristics of existing online PNIs reported in the literature. METHODS A scoping review based on the guidelines outlined in the Joanna Briggs Institute framework was conducted. A search for peer-reviewed literature published between 1989 and 2022 on online PNIs was conducted using MEDLINE, CINAHL, Embase, PsycInfo, and Cochrane Library databases. Two independent reviewers conducted 2 levels of screening. Data abstraction was conducted to outline key study characteristics (eg, study design, population, and intervention characteristics). The data were analyzed using descriptive statistics and qualitative content analysis. RESULTS A total of 100 studies met the inclusion criteria. Our findings indicate that a variety of study designs are used to describe and evaluate online PNIs, with literature being published between 2003 and 2022 in Western countries. Of these studies, 39 (39%) studies were randomized controlled trials. In addition, we noticed an increase in reported online PNIs since 2019. The majority of studies involved White females with a diagnosis of cancer and a lack of participants aged 70 years or older was observed. Most online PNIs provide support through navigation, self-management and lifestyle changes, counseling, coaching, education, or a combination of support. Variation was noted in terms of mode of delivery, duration, and frequency. Only a small number of studies described theoretical frameworks or change mechanisms to guide intervention. CONCLUSIONS To our knowledge, this is the first review to comprehensively synthesize the existing literature on online PNIs, by focusing on the characteristics of interventions and studies in this area. Inconsistency in reporting the country of publication, population characteristics, duration and frequency of interventions, and a lack of the use of underlying theories and working mechanisms to inform intervention development, provide guidance for the reporting of future online PNIs.
Collapse
Affiliation(s)
- Meghan Marsh
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Syeda Rafia Shah
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Sarah E P Munce
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
- KITE, Toronto Rehabiliation Institute, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Laure Perrier
- Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | | | | | - Kristina Marie Kokorelias
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
- Section of Geriatrics, Sinai Health and University Health Network, Toronto, ON, Canada
| |
Collapse
|
7
|
Koob C, Stuenkel M, Gagnon RJ, Griffin SF, Sease K. Examining Patient- and Community-Level Factors Associated with Pediatric Mental Healthcare Access Within a Patient Navigation Program. Community Ment Health J 2024; 60:1055-1067. [PMID: 38507129 PMCID: PMC11199227 DOI: 10.1007/s10597-024-01258-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 02/18/2024] [Indexed: 03/22/2024]
Abstract
In 2021, national leaders in the United States declared a "national youth mental health crisis." Still, only 1-in-4 children receive adequate mental healthcare access. Patient Navigator Programs (PNPs) can improve children's referral-to-connection to mental health services. We examined patient- and community-level factors associated with pediatric mental healthcare access. Pediatric Support Services (PSS) is a PNP that triages mental and behavioral health referrals within a large health system in a southeastern state. This study analyzes PSS data from September 2017-March 2023 and Child Opportunity Index 2.0 state-normed zip-code level data to assess social drivers of health estimates. Structural equation modeling was conducted between patient- and community-level factors and connection to mental health services. Overall, 62.7% of children connected to mental health services since PSS' inception. Regardless of SDOH, as children get older, they are more likely to connect with mental health services (β = .053, SE = .010, p < .001). Children with greater number of referral needs are more likely to connect with mental health services (β = .034, SE = .011, p = .002). Further, children who live in communities with higher opportunity levels are more likely to connect with mental health services (β = .016, SE = .008, p = .040), suggesting that children who live in low-income communities experience more barriers to mental healthcare. Social drivers may inform referral practices and tiered navigation support for optimal mental healthcare access among children. Further research should demonstrate the effectiveness of PNPs integrated within healthcare and community-based settings.
Collapse
Affiliation(s)
- Caitlin Koob
- Department of Public Health Sciences, Clemson University, 501 Edwards Hall, Clemson, SC, 29634, USA.
- Prisma Health Children's Hospital-Upstate, Greenville, SC, USA.
| | | | - Ryan J Gagnon
- Department of Parks, Recreation, Tourism, and Management, Clemson University, Clemson, SC, USA
| | - Sarah F Griffin
- Department of Public Health Sciences, Clemson University, 501 Edwards Hall, Clemson, SC, 29634, USA
| | - Kerry Sease
- Prisma Health Children's Hospital-Upstate, Greenville, SC, USA
- University of South Carolina School of Medicine Greenville, Greenville, SC, USA
| |
Collapse
|
8
|
Barroso E, Mark T, Acevedo R, Rao S, Jordan H, Burzynski J, Remegio W, Ea E, Compas L. Patient navigator's role in latent tuberculosis infection at a New York City Health Department Chest Clinic. J Clin Tuberc Other Mycobact Dis 2024; 36:100446. [PMID: 38708035 PMCID: PMC11070235 DOI: 10.1016/j.jctube.2024.100446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
Background Philippines is one of the top ten countries of birth among individuals with tuberculosis in New York City (NYC). The NYC Health Department (HD) screened Filipino-born New Yorkers for latent TB infection (LTBI), but few of those tested positive completed evaluation and treatment. Objective To increase the proportion of Filipinos with a positive QuantiFeron-TB Gold Plus (QFT-Plus) complete LTBI evaluation and treatment. Methods Nine community-based LTBI screening events were conducted during September-December 2021. Patients with positive QFT-Plus results were offered no-cost LTBI evaluation and treatment at HD Chest Clinic. The HD engaged culturally- and linguistically-competent Filipino patient navigators (PN) to facilitate LTBI evaluation and treatment. Results Of 77 Filipinos screened, 17 (22%) tested positive. Fourteen (82%) were evaluated for LTBI; eight of the 14 (57%) completed LTBI treatment. Conclusions Pairing patients with culturally- and linguistically- competent Filipino PNs contributed to an increase in the proportion of Filipinos with a positive QFT-Plus who completed LTBI evaluation and treatment. TB prevention programs may wish to consider PNs in LTBI patient care.
Collapse
Affiliation(s)
- E. Barroso
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Queens, NY, USA
- Philippine Nurses Association of New York, New York, NY, USA
| | - T. Mark
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | - R. Acevedo
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | - S. Rao
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | - H.T. Jordan
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | - J. Burzynski
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | - W. Remegio
- Philippine Nurses Association of New York, New York, NY, USA
| | - E. Ea
- Kalusugan Coalition, Queens, NY, USA
| | - L. Compas
- Philippine Nurses Association of New York, New York, NY, USA
| |
Collapse
|
9
|
Yu WZ, Wang HF, Lin YK, Liu YL, Yen Y, Whang-Peng J, Huang TW, Chang HJ. The Effect of Oncology Nurse Navigation on Mental Health in Patients with Cancer in Taiwan: A Randomized Controlled Clinical Trial. Curr Oncol 2024; 31:4105-4122. [PMID: 39057178 PMCID: PMC11276177 DOI: 10.3390/curroncol31070306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Revised: 07/13/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
In this study, we investigated the prevalence of mental health problems among patients with cancer and whether oncology nurse navigation improved their mental health outcomes and medical experience. In this randomized controlled clinical trial, we recruited 128 outpatients with cancer via purposive sampling from a teaching hospital in northern Taiwan. Participants were randomly assigned to the navigation group (N = 61) or the usual care group (N = 67). Data were collected from January 2019 to July 2020 using questionnaires, including the self-reported Distress Thermometer, Hospital Anxiety and Depression Scale, Demoralization Scale, and Patient Assessment of Chronic Illness Care. Data were collected at baseline and after three and six months of the intervention. Descriptive and analytical statistical analyses were performed. The prevalence rates of anxiety, depression, distress, and demoralization were 17.9%, 15.7%, 29.7%, and 29.7%, respectively. After three months, the participants in the navigation group exhibited significantly reduced levels of anxiety, demoralization, and emotional distress (reduced by 92%, 75%, and 58%, respectively) and reported a better medical experience (odds ratio = 1.40) than those in the usual care group.
Collapse
Affiliation(s)
- Wei-Zhen Yu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei 110301, Taiwan;
| | - Hsin-Fang Wang
- Taipei Cancer Center, Taipei Medical University, Taipei 110301, Taiwan; (H.-F.W.); (Y.-L.L.); (J.W.-P.)
| | - Yen-Kuang Lin
- Graduate Institute of Athletics and Coaching Science, National Taiwan Sport University, Taoyuan 333325, Taiwan;
| | - Yen-Lin Liu
- Taipei Cancer Center, Taipei Medical University, Taipei 110301, Taiwan; (H.-F.W.); (Y.-L.L.); (J.W.-P.)
- Pediatric Oncology, Department of Pediatrics, Taipei Medical University Hospital, Taipei 110301, Taiwan
- Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
| | - Yun Yen
- Program for Cancer Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei 110301, Taiwan;
| | - Jacqueline Whang-Peng
- Taipei Cancer Center, Taipei Medical University, Taipei 110301, Taiwan; (H.-F.W.); (Y.-L.L.); (J.W.-P.)
| | - Tsai-Wei Huang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei 110301, Taiwan;
- Research Center in Nursing Clinical Practice, Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, 116079, Taiwan
| | - Hsiu-Ju Chang
- Department of Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Efficient Smart Care Research Center, College of Nursing, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| |
Collapse
|
10
|
Balzano G, Reni M, Di Bartolomeo M, Scorsetti M, Caraceni A, Rivizzigno P, Amorosi A, Scardoni A, Abu Hilal M, Ferrari G, Labianca R, Venturini M, Doglioni C, Riva L, Caccialanza R, Carrara S. Translating knowledge into policy: Organizational model and minimum requirements for the implementation of a regional pancreas unit network. Dig Liver Dis 2024:S1590-8658(24)00776-X. [PMID: 38851973 DOI: 10.1016/j.dld.2024.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/14/2024] [Accepted: 05/16/2024] [Indexed: 06/10/2024]
Abstract
Pancreatic and periampullary cancers pose significant challenges in oncological care due to their complexity and diagnostic difficulties. Global experiences underscore the crucial role of multidisciplinary collaboration and centralized care in improving patient outcomes in this context. Recognizing these challenges, Lombardy, Italy's most populous region, embarked on establishing pancreas units across its territory to enhance clinical outcomes and organizational efficiency. This initiative, driven by a multistakeholder approach involving the Lombardy Welfare Directorate, clinicians, and a patient association, emphasizes the centralization of complex care in high-volume hospitals, adopting a hub-and-spoke model and a multidisciplinary approach. This article outlines the process and criteria set forth for pancreas unit implementation, aiming to provide a structured framework for enhancing pancreatic cancer care. Central to this initiative is the establishment of structured criteria and minimal requirements, not only for surgery but also for other essential components of care, ensuring a comprehensive approach to pancreatic cancer management. The Lombardy model offers a structured framework for enhancing pancreatic cancer care, with potential applicability to other regions and countries seeking to improve their cancer care infrastructure.
Collapse
Affiliation(s)
- Gianpaolo Balzano
- Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
| | - Michele Reni
- Department of Medical Oncology, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20123, Milan, Italy
| | - Maria Di Bartolomeo
- Gastrointestinal Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Via Giacomo Venezian, 1, 20133, Milan, Italy
| | - Marta Scorsetti
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano 20089, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
| | - Augusto Caraceni
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano Via della Commenda 19 20122 Milan, Italy
| | - Piero Rivizzigno
- Codice Viola, Pancreatic Cancer Advocacy Group, 20855, Lesmo (MB), Italy
| | - Alessandro Amorosi
- Welfare General Directorate, Regione Lombardia; Palazzo Lombardia, Piazza Città di Lombardia, 1, 20124 Milan, Italy
| | - Alessandro Scardoni
- Welfare General Directorate, Regione Lombardia; Palazzo Lombardia, Piazza Città di Lombardia, 1, 20124 Milan, Italy
| | - Mohammad Abu Hilal
- Department of Surgery, Fondazione Poliambulanza, Via Bissolati 57, Brescia 25124, Italy
| | - Giovanni Ferrari
- Division of Minimally-Invasive Oncologic Surgery ASST GOM Niguarda Nigurda Hospital, Milan, Italy
| | | | - Massimo Venturini
- Department of Diagnostic and Interventional Radiology, Circolo Hospital, ASST Sette Laghi, 21100, Varese, Italy; Department of Medicine and Technological Innovation (DIMIT), Insubria University, Varese, Italy
| | - Claudio Doglioni
- Department of Anatomic Pathology, University Vita-Salute San Raffaele, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Luca Riva
- Frailty Department, Local Network of Palliative Care, ASST, Lecco, Italy
| | - Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinco San Matteo, Pavia, Italy
| | - Silvia Carrara
- IRCCS Humanitas Research Hospital - Endoscopic Unit, Department of Gastroenterology, Via Manzoni 56, 20089 Rozzano (Milan), Italy
| |
Collapse
|
11
|
Feyereisen S, Puro N. Advanced practice nurse case managers improve efforts by US hospitals to address patient social needs. J Adv Nurs 2024; 80:2577-2583. [PMID: 37909487 DOI: 10.1111/jan.15937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 09/24/2023] [Accepted: 10/23/2023] [Indexed: 11/03/2023]
Abstract
AIMS US hospitals are focussing more than ever on meeting important patient social needs. Patients often make multiple trips to hospitals related to nonmedical issues that could likely be averted through the increased integration of case management strategies. Although the percentage of hospitals using advanced practice nurses (APNs) in this role is still relatively low, we explore the idea that employing APN case managers improves hospitals' abilities to alleviate hospital overusage. DESIGN The study used a cross-sectional design. METHODS We used the 2021 American Hospital Association data set, which includes 5855 hospitals, of which 4315 were general medical hospitals. RESULTS Using descriptive statistics and Poisson regression, we discovered that employing APN case managers in US acute care hospitals is associated with an increased likelihood that hospitals will implement strategies addressing patient social needs. CONCLUSIONS When hospitals screen patients for social needs and formulate and implement internal and external strategies designed to meet patient social needs, many stakeholders stand to benefit. Should more hospitals observe such benefits when utilizing an APN case manager model, it will likely proliferate, and demand for APNs could accelerate further. IMPACT Following the reduction in unnecessary patient visits and readmissions, hospitals' scarce resources are freed up to offer timely care to patients that are truly medically in need. Furthermore, financial performance improves under this scenario. APNs play a critical role in enabling hospitals to realize such benefits. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. We used archival data in this study.
Collapse
Affiliation(s)
- Scott Feyereisen
- Department of Management Programs, College of Business, Florida Atlantic University, Boca Raton, Florida, USA
| | - Neeraj Puro
- Department of Management Programs, College of Business, Florida Atlantic University, Boca Raton, Florida, USA
| |
Collapse
|
12
|
Groot G, Marques Santos JD, Witham S, Leeder E, Carr T. "Somebody That can Meet you on Your Level:" Cancer Survivors' Perspectives on the Role of Indigenous Patient Navigators in Cancer Care. Can J Nurs Res 2024; 56:178-188. [PMID: 38373404 PMCID: PMC11032001 DOI: 10.1177/08445621241230099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Cancer incidence has increased for First Nations and Métis Peoples in Canada over recent years. Despite a growing cancer burden, there remain challenges to accessing culturally appropriate and quality care in Saskatchewan. OBJECTIVE The study aimed to explore, from cancer survivors' perspectives, the potential of Indigenous patient navigators to enhance the healthcare experiences of First Nations and Métis cancer survivors in Saskatchewan. METHODS We conducted semi-structured interviews with 19 First Nations and Métis cancer survivors. Participants were interviewed by phone between May 2022 to March 2023. Thematic analysis was conducted to generate themes, categories, and codes reflecting participants' experiences with patient navigators. RESULTS Participants reported several supports to help patients with cancer through their cancer journey, including family, community, traditional ways, and First Nations and Métis health support services. Challenges to accessing care included language and communication barriers, logistical challenges, cultural differences, financial challenges, and gaps in care. Indigenous patient navigators may play a critical role in overcoming barriers by providing communication, translation, coordination, education, advocacy, and guidance to Indigenous cancer survivors. In participants' view, the tasks of Indigenous patient navigators could vary, ranging from helping schedule appointments to advocating for the patient's treatment preferences. In addition, Indigenous patient navigators could be helpful bridging Western medicine with traditional medicine when supporting patients seeking cancer care. CONCLUSION According to study participants, Indigenous patient navigators could be beneficial to Indigenous cancer survivors in Saskatchewan.
Collapse
Affiliation(s)
- Gary Groot
- Department of Community Health and Epidemiology and Department of Surgery, University of Saskatchewan, Saskatoon, Canada
| | | | - Stephanie Witham
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada
| | - Erin Leeder
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada
| | - Tracey Carr
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada
| |
Collapse
|
13
|
Li C, Gong X, Wei Z, Gao L, Graham Y, Yang W. Novice Chinese Bariatric Nurses' Perceptions of Their Role as Bariatric Case Managers: A Qualitative Study. Obes Surg 2024; 34:1464-1470. [PMID: 38504064 DOI: 10.1007/s11695-024-07177-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 03/21/2024]
Abstract
INTRODUCTION Bariatric case managers (BCM) are integral healthcare team members for patients undergoing bariatric surgery in China. As the demand for bariatric surgery increases in China, the number of BCMs has also risen. However, more is needed to know about the perceptions of novice bariatric nurses toward their role as case managers. This study aims to investigate the perceptions of novice Chinese bariatric nurses toward their roles during the early stages of their careers. METHODS This qualitative study employed semi-structured individual interviews with 15 novice bariatric nurses who received training as BCMs. The interviews were audio-recorded, transcribed line-by-line, and analyzed thematically. The study was conducted in a bariatric surgery center of a public tertiary hospital in Southern China. RESULTS Three themes emerged from the data related to the perceptions of being a BCM: "negotiating the ambiguity of the BCM role," "establishing a core set of behaviors for the BCM role," and "identifying areas of competence to develop a BCM role framework." The novice bariatric nurses expressed both positive and negative feelings toward their role. They highlighted the need for further training to improve their qualifications and the importance of support from colleagues, and hospital management. CONCLUSIONS The findings illuminate the role of the BCM in China. Future research should investigate effective and acceptable job descriptions and cooperation modes between BCMs, colleagues and hospital management. We recommend using these findings to develop training programs for novice BCMs and improve their capacity to provide quality care to patients undergoing bariatric surgery.
Collapse
Affiliation(s)
- Chunqun Li
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Avenue West, Guangzhou, Guangdong Province, China
| | - Xue Gong
- School of Medical Technology and Nursing, Shenzhen Polytechnic University, Xili Lake, Nanshan District, Shenzhen, Guangdong Province, China
| | - Zhuoqi Wei
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Avenue West, Guangzhou, Guangdong Province, China
| | - Lilian Gao
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Avenue West, Guangzhou, Guangdong Province, China
| | - Yitka Graham
- Helen McArdle Nursing and Care Research Institute, University of Sunderland, Sunderland, SR1 3SD, UK.
- Bariatric Surgical Unit, South Tyneside and Sunderland NHS Foundation Trust, Kayll Road, Sunderland, SR4 7TP, UK.
- Faculty of Psychology, University of Anahuac, Mexico City, Mexico.
- Department of Biomedical Sciences, University Hospital Austral, Buenos Aires, Argentina.
| | - Wah Yang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Avenue West, Guangzhou, Guangdong Province, China.
| |
Collapse
|
14
|
Harris SA, Eapen V, Kohlhoff J. Implementing a National Navigation Service for Perinatal and Infant Mental Health: Early Learnings from the ForWhen Model. Community Ment Health J 2024; 60:581-588. [PMID: 37991577 DOI: 10.1007/s10597-023-01211-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 11/08/2023] [Indexed: 11/23/2023]
Abstract
ForWhen is an Australia-based national navigation service aimed at helping parents and carers navigate the perinatal mental health service landscape and connect them with appropriate support and clinical services. The current study forms part of a mixed-methods evaluation of the ForWhen program. Semi-structured interviews were conducted with ForWhen navigators during the early design and implementation phases of the service. Results were used to characterise the ForWhen navigator activities and responsibilities, identify navigator core competencies, and examine facilitators and barriers to successful implementation of a large-scale navigation program for perinatal and infant mental health. Further research will be crucial for evidencing the utility and potential of navigation models in addressing identified issues with access to treatment for perinatal and infant mental health issues.
Collapse
Affiliation(s)
- Sophia A Harris
- Discipline of Psychiatry & Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Valsamma Eapen
- Discipline of Psychiatry & Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
- Academic Unit of Infant, Child & Adolescent Psychiatry Services (AUCS), South Western Sydney Local Health District and Ingham Institute, Sydney, Australia
| | - Jane Kohlhoff
- Discipline of Psychiatry & Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia.
- , Karitane, Sydney, Australia.
| |
Collapse
|
15
|
Ethier A, Dubois MF, Savaria V, Carrier A. Tensions experienced by case managers working in home care for older adults in Quebec: first level analysis of an institutional ethnography. BMC Health Serv Res 2024; 24:296. [PMID: 38448879 PMCID: PMC10918893 DOI: 10.1186/s12913-024-10709-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/12/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Case managers play a vital role in integrating the necessary services to optimise health-related goals and outcomes. Studies suggest that in home care, case managers encounter tensions in their day-to-day work, that is, disjuncture between what they should do, in theory, and what they actually do, in practice. However, direct exploration of these tensions is lacking. As such, this study aimed to describe the tensions encountered by case managers in public home care for older adults in Quebec and their influence on day-to-day work. METHODS An institutional ethnography was conducted through observations of work, interviews and a survey with case managers working in home care in Quebec. Data were analysed using institutional ethnography first-level analysis procedures. This included mapping the work sequences as well as identifying the tensions experienced by case managers through the words they used. RESULTS Three main tensions were identified. First, case managers perceive that, despite working to return hospitalised older adults at home safely, their work also aims to help free up hospital beds. Thus, they often find themselves needing to respond quickly to hospital-related inquiries or expedite requests for home care services. Second, they are supposed to delegate the care to "partners" (e.g., private organisations). However, they feel that they are in effect managing the quality of the services provided by the "partners." Consequently, they go to great lengths to ensure that good care will be provided. Finally, they must choose between meeting organisational requirements (e.g., reporting statistics about the work, documenting information in the older adults' file, doing mandatory assessments) and spending time providing direct care. This often leads to prioritising direct care provision over administrative tasks, resulting in minimal reporting of essential information. CONCLUSION The results are discussed using the three lenses of professional practice context analyses (i.e., accountability, ethics, and professional-as-worker) to formulate recommendations for practice and research. They suggest that, despite their important role, case managers have limited power in home care (e.g., with partners, with the hospital).
Collapse
Affiliation(s)
- Alexandra Ethier
- École de réadaptation, Faculté de médecine et des sciences de la santé , Université de Sherbrooke; Centre de recherche sur le vieillissement, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada.
| | - Marie-France Dubois
- Département des sciences de la santé communautaire, Faculté de médecine et sciences de la santé, Université de Sherbrooke; Centre de recherche sur le vieillissement, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada
| | - Virginie Savaria
- École de réadaptation, Faculté de médecine et des sciences de la santé , Université de Sherbrooke; Centre de recherche sur le vieillissement, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada
| | - Annie Carrier
- École de réadaptation, Faculté de médecine et des sciences de la santé , Université de Sherbrooke; Centre de recherche sur le vieillissement, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada
| |
Collapse
|
16
|
López-Pérez MI, Molina-Rodríguez A, Harillo-Acevedo FD, Guillén-Martínez A, Palacio-Gaviria MP. Approach to the care process by nurse case managers in a breast unit. ENFERMERIA CLINICA (ENGLISH EDITION) 2024; 34:90-95. [PMID: 38484933 DOI: 10.1016/j.enfcle.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 01/28/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVE Breast units led by nurse case managers are being implemented to provide comprehensive care in the detection and treatment of breast cancer. However, their implementation is heterogeneous and the results of the care process with this professional have not been studied. The aim of the study is to describe the management in time and the approach of the process by a nurse case manager in the breast unit of women with suspected breast cancer pathology, derived from the breast cancer screening program. METHODS Descriptive, cross-sectional, retrospective study carried out in 2021. Women treated in a breast unit managed by a nurse case manager in a hospital in southern Spain were included. Sociodemographic, clinical and care process characteristics were analysed RESULTS: A total of 118 women of Spanish nationality (92%) participated, with a mean age of 59 years. The diagnosis of malignancy was made in 74.6% of them. Seventy-nine percent of the women had their first visit within 3 days. The mean time to diagnosis was 3.98 days (SD: ±3.93), 4.2 weeks (SD: ±1.84) to initiate treatment and a total in-hospital time of 33 days (SD: ±13.45). CONCLUSIONS The management of nurse case managers in breast units contributes to improving or speeding up times, in accordance with international guidelines, helping this approach in the continuity of the care process for women referred after screening for breast cancer detection.
Collapse
|
17
|
Kokorelias KM, Lee TSJ, Bayley M, Seto E, Toulany A, Nelson MLA, Dimitropoulos G, Penner M, Simpson R, Munce SEP. A Web-Based Peer-Patient Navigation Program (Compassionate Online Navigation to Enhance Care Transitions) for Youth Living With Childhood-Acquired Disabilities Transitioning From Pediatric to Adult Care: Qualitative Descriptive Study. JMIR Pediatr Parent 2024; 7:e47545. [PMID: 38324351 PMCID: PMC10882481 DOI: 10.2196/47545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 11/13/2023] [Accepted: 12/04/2023] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Studies have highlighted significant challenges associated with the transition from pediatric to adult health and social care services for youth living with childhood-acquired disabilities and their caregivers. Patient navigation has been proposed as an effective transitional care intervention. Better understanding of how patient navigation may support youth and their families during pediatric to adult care transitions is warranted. OBJECTIVE This study aims to describe the preferred adaptations of an existing web-based platform from the perspectives of youth with childhood-onset disabilities and their family caregivers to develop a web-based peer-patient navigation program, Compassionate Online Navigation to Enhance Care Transitions (CONNECT). METHODS A qualitative descriptive design was used. Participants included youth living with childhood-acquired disabilities (16/23, 70%) and their caregivers (7/23, 30%). Semistructured interviews and focus groups were conducted, digitally recorded, and transcribed. Thematic analysis was used to analyze the data and was facilitated through NVivo software (Lumivero). RESULTS Participants desired a program that incorporated (1) self-directed learning, (2) a library of reliable health and community resources, and (3) emotional and social supports. On the basis of participants' feedback, CONNECT was deemed satisfactory, as it was believed that the program would help support appropriate transition care through the provision of trusted health-related information. Participants highlighted the need for options to optimize confidentiality in their health and social care and the choice to remain anonymous to other participants. CONCLUSIONS Web-based patient navigation programs such as CONNECT may deliver peer support that can improve the quality and experience of care for youth, and their caregivers, transitioning from pediatric to adult care through personalized support, health care monitoring, and health and social care resources. Future studies are needed to test the feasibility, acceptability, usability, use, and effectiveness of CONNECT among youth with childhood-onset disabilities.
Collapse
Affiliation(s)
- Kristina Marie Kokorelias
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
- Department of Occupational Sciences and Occupational Therapy, Temetry Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temetry Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tin-Suet Joan Lee
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
| | - Mark Bayley
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temetry Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada
| | - Emily Seto
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Center for Digital Therapeutics, University Health Network, Toronto, ON, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Alene Toulany
- Department of Adolescent Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Michelle L A Nelson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | | | - Melanie Penner
- Department of Pediatrics, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Robert Simpson
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences, Toronto, ON, Canada
| | - Sarah E P Munce
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
- Department of Occupational Sciences and Occupational Therapy, Temetry Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temetry Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
18
|
Hogue A, Satcher MF, Drazdowski TK, Hagaman A, Hibbard PF, Sheidow AJ, Coetzer-Liversage A, Mitchell SG, Watson DP, Wilson KJ, Muench F, Fishman M, Wenzel K, de Martell SC, Stein LAR. Linkage facilitation services for opioid use disorder: Taxonomy of facilitation practitioners, goals, and activities. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 157:209217. [PMID: 37981242 PMCID: PMC10922806 DOI: 10.1016/j.josat.2023.209217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 07/14/2023] [Accepted: 11/13/2023] [Indexed: 11/21/2023]
Abstract
INTRODUCTION This article proposes a taxonomy of linkage facilitation services used to help persons with opioid use disorder access treatment and recovery resources. Linkage facilitation may be especially valuable for persons receiving medication for opioid use disorder (MOUD) given the considerable barriers to treatment access and initiation that have been identified. The science of linkage facilitation currently lacks both consistent communication about linkage facilitation practices and a conceptual framework for guiding research. METHODS To address this gap, this article presents a taxonomy derived from expert consensus that organizes the array of practitioners, goals, and activities associated with linkage services for OUD and related needs. Expert panelists first independently reviewed research reports and policy guidelines summarizing the science and practice of linkage facilitation for substance use disorders generally and OUD specifically, then met several times to vet the conceptual scheme and content of the taxonomy until they reached a final consensus. RESULTS The derived taxonomy contains eight domains: facilitator identity, facilitator lived experience, linkage client, facilitator-client relationship, linkage activity, linkage method, linkage connectivity, and linkage goal. For each domain, the article defines basic domain categories, highlights research and practice themes in substance use and OUD care, and introduces innovations in linkage facilitation being tested in one of two NIDA-funded research networks: Justice Community Opioid Innovation Network (JCOIN) or Consortium on Addiction Recovery Science (CoARS). CONCLUSIONS To accelerate consistent application of this taxonomy to diverse research and practice settings, the article concludes by naming several considerations for linkage facilitation workforce training and implementation.
Collapse
Affiliation(s)
- Aaron Hogue
- Partnership to End Addiction, 711 Third Avenue, 5th floor, New York, NY 10017, United States of America.
| | - Milan F Satcher
- Dartmouth Health and Geisel School of Medicine at Dartmouth College, United States of America
| | | | - Angela Hagaman
- East Tennessee State University, United States of America
| | | | | | | | | | | | | | - Frederick Muench
- Partnership to End Addiction, 711 Third Avenue, 5th floor, New York, NY 10017, United States of America
| | - Marc Fishman
- Maryland Treatment Centers, United States of America
| | - Kevin Wenzel
- Maryland Treatment Centers, United States of America
| | | | - L A R Stein
- Department of Psychology, University of Rhode Island, United States of America; Department of Behavioral & Social Sciences, Brown University, United States of America; Department of Behavioral Healthcare, Developmental Disabilities & Hospitals, RI, United States of America
| |
Collapse
|
19
|
Zinck MJ, Minichiello SN, Fick CA, Sawry S, Fonner VA. Virtual case management: a differentiated approach to HIV prevention, treatment, and care. AIDS 2024; 38:145-151. [PMID: 37861692 PMCID: PMC10734782 DOI: 10.1097/qad.0000000000003762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/15/2023] [Accepted: 10/13/2023] [Indexed: 10/21/2023]
|
20
|
Kokorelias KM, Singh H, Thompson AN, Nesbitt AE, Shiers-Hanley JE, Nelson MLA, Hitzig SL. Occupational Therapists in Patient Navigation: A Scoping Review of the Literature. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2024; 44:117-127. [PMID: 37070245 PMCID: PMC10676038 DOI: 10.1177/15394492231161283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
This review seeks to understand the literature on patient navigator programs (PNPs) that employ occupational therapists (OTs), including the role (conceptualization), functions (operationalization) of OTs who work as patient navigators (PNs) and the settings and populations they serve. This review also mapped the role of PNs to the 2021 Competencies for Occupational Therapists in Canada. Scoping review methodology by Arksey and O'Malley (2005) was employed. Data were analyzed thematically and numerically to identify frequent patterns. Ten articles were included. Within PNPs, OTs worked in hospitals and communities, but their role was rarely well-defined. Five competency domains (i.e., communication and collaboration, culture, equity and justice, excellence in practice, professional responsibility, and engagement with the profession) were evident in existing PNPs that included OTs. This review supports the increasing interest in OTs as PNs by demonstrating the alignment between the OT competencies and roles and functions of OTs working within PNPs.
Collapse
Affiliation(s)
- Kristina M. Kokorelias
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- University of Toronto, Ontario, Canada
| | | | | | | | | | | | - Sander L. Hitzig
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- University of Toronto, Ontario, Canada
| |
Collapse
|
21
|
陶 文, 文 进, 李 为. [Utilizing Patient Navigation Model in the Whole-Process Management of Lung Cancer in the Context of Medical Consortiums in China: Insights and Reflections]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2023; 54:1288-1293. [PMID: 38162072 PMCID: PMC10752780 DOI: 10.12182/20231160301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Indexed: 01/03/2024]
Abstract
Patient navigation is an effective intervention measure to promote the integration of medical systems and services. By providing individualized, coordinated, and continuous care, patient navigation offers a way to address the problem of fragmented services across institutions and levels of care in the whole-process management of lung cancer, providing assistance to patients with complex healthcare needs. Herein, we reviewed the origin, the development, the models, and the application status of patient navigation in China and other countries. We also analyzed the considerations regarding introducing patient navigation in the whole-process management of lung cancer against the background of medical consortiums in China, discussing why patient navigation should be introduced, how to introduce patient navigation, as well as potential challenges and coping strategies. Patient navigation meets the current needs for equitable, accessible, systematic, continuous, and integrated prevention and treatment services for chronic diseases in the context of the Healthy China Strategy. It helps fill the gaps in the continuity and coordination of whole-process management of lung cancer patients in the context of medical consortiums. However, introducing patient navigation in medical consortiums involving multiple institutions and levels of care may face challenges, including incompatibility between the health information systems of different institutions, poor cross-institutional collaboration and communication, and limited resources. Further improvement is needed in medical informatization, coordination and communication mechanisms, and benefit distribution mechanisms within the medical consortiums. In this paper, we intend to provide insights and suggestions for developing patient navigation models that suit China's local characteristics and for promoting the implementation and development of whole-process management of lung cancer in the context of the medical consortium system.
Collapse
Affiliation(s)
- 文娟 陶
- 四川大学华西医院 医院管理研究所 (成都 610041)Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 进 文
- 四川大学华西医院 医院管理研究所 (成都 610041)Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 为民 李
- 四川大学华西医院 医院管理研究所 (成都 610041)Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu 610041, China
- 四川大学华西医院 院长办公室 (成都 610041)President's Office, West China Hospital, Sichuan University, Chengdu 610041, China
| |
Collapse
|
22
|
Nothelle S, Nkodo A, Fiddler K, Litman J, Sleppy R, Brancati F, Boyd CM, Wolff JL. Care manager, older adult, and caregiver perspectives on co-occurring care management among high-need older adults. J Am Geriatr Soc 2023; 71:3424-3434. [PMID: 37539948 PMCID: PMC10838368 DOI: 10.1111/jgs.18531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/23/2023] [Accepted: 07/05/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Care management programs are widely used to improve care coordination and management of chronic conditions for high-need older adults. With many care management programs targeting a small number of people, high-need older adults may receive services from more than one care management program (co-occurring care management), the implications of which are unknown. METHODS We conducted semi-structured interviews with 37 care managers, 15 older adults, and 13 caregivers, who were recruited through an urban academic medical center and a large rural health system in Maryland. We analyzed interview transcripts using qualitative content analysis with the aim of understanding contributors to, implications of, and strategies to manage co-occurring care management among high-need older adults. RESULTS Contributors to co-occurring care management included siloed programs due to program-specific financial incentives and inability to easily identify other involved care managers, and the complex needs of the enrolled older adult population, which motivated involvement of more than one program. Implications of co-occurring care management included older adults and caregivers feeling cared for and safe when they had multiple care management programs involved and reporting value in their relationships with care managers. Older adults were identified as having greater access to resources and improved care when care manager roles were aligned in a complementary way; however, misaligned roles posed the potential for confusion about care manager accountability for tasks and resulted in frustration and lack of follow-through. Strategies for managing co-occurring care management included alignment of care manager roles through communication and negotiation and older adults and caregivers identifying and relying on a single care manager with whom they had the strongest relationship. CONCLUSIONS Initiatives that clarify strengthen the relationship between care managers and older adults, increase care manager visibility, and facilitate communication across care managers may help foster collaboration.
Collapse
Affiliation(s)
- Stephanie Nothelle
- Center for Transformative Geriatrics Research, Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Center for Aging and Health, Johns Hopkins University, Baltimore, MD
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Roger C. Lipitz Center for Integrated Health Care, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Amelie Nkodo
- Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | | | - Jessica Litman
- Department of Family Medicine, Baylor Scott and White, Round Rock, TX
| | - Rosalie Sleppy
- Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Cynthia M Boyd
- Center for Transformative Geriatrics Research, Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Center for Aging and Health, Johns Hopkins University, Baltimore, MD
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Roger C. Lipitz Center for Integrated Health Care, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jennifer L Wolff
- Center for Transformative Geriatrics Research, Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Center for Aging and Health, Johns Hopkins University, Baltimore, MD
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Roger C. Lipitz Center for Integrated Health Care, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| |
Collapse
|
23
|
Mendes C, Carvalho M, Oliveira L, Rodrigues LM, Gregório J. Nurse-led intervention for the management of bariatric surgery patients: A systematic review. Obes Rev 2023; 24:e13614. [PMID: 37607837 DOI: 10.1111/obr.13614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 06/16/2023] [Accepted: 06/24/2023] [Indexed: 08/24/2023]
Abstract
The prevalence of obesity has become a global health concern, and severe obesity is associated with various chronic diseases and decreased quality of life. Bariatric surgery has shown success in treating obesity. Nevertheless, some patients experience weight regain and unsatisfactory outcomes. Multidisciplinary interventions have been shown to improve postoperative outcomes. Case managers, often specialized nurses, play a crucial role in patient support and coordination of care. However, the diverse design of case-managing interventions hinders the assessment of their success. Thus, the aim of this review is to identify the most successful structural characteristics of case-managing interventions, with or without the support of e-Health, in the process of perioperative management of bariatric surgery patients. A systematic literature review was conducted following the PRISMA guidelines. PubMed, MEDLINE, EBSCOhost, and CINAHL databases were searched for relevant studies published in the last 10 years. Eligible studies included randomized controlled trials, controlled clinical studies, case studies, or observational studies that evaluated perioperative care in bariatric surgery. The PICO framework was used to frame the search strategy. The initial search yielded 225 articles, of which 10 studies met the inclusion criteria. Nurse-led case-managing interventions with a multidisciplinary approach showed positive results in weight loss, physical activity, and quality of life. Patient-centered care models were found to promote adherence to treatment and patient satisfaction. E-Health technologies improved quality of life but not weight loss. The duration of behavioral interventions and the long-term outcomes after surgery remained unclear. Nurse-led case-management interventions, with a focus on behavioral change and multidisciplinary approaches, show promise in improving outcomes in bariatric surgery patients. Patient-centered care models and longer term interventions may contribute to sustained weight loss and better postoperative outcomes. Further research is needed to determine the optimal duration of interventions and the long-term effects on weight maintenance.
Collapse
Affiliation(s)
- Cláudia Mendes
- Hospital Espírito Santo de Évora, EPE, Évora, Portugal
- CRI.COM-Centro Responsabilidade Integrada de Cirurgia da Obesidade e Metabólica, Évora, Portugal
- CBIOS-Universidade Lusófona's Research Center for Biosciences and Health Technologies, Lisbon, Portugal
- Escuela de Doctorado, Programa de Ciencias de la Salud, Universidade de Alcalá, Madrid, Spain
| | - Manuel Carvalho
- Hospital Espírito Santo de Évora, EPE, Évora, Portugal
- CRI.COM-Centro Responsabilidade Integrada de Cirurgia da Obesidade e Metabólica, Évora, Portugal
| | - Leandro Oliveira
- CBIOS-Universidade Lusófona's Research Center for Biosciences and Health Technologies, Lisbon, Portugal
| | - Luís Monteiro Rodrigues
- CBIOS-Universidade Lusófona's Research Center for Biosciences and Health Technologies, Lisbon, Portugal
| | - João Gregório
- CBIOS-Universidade Lusófona's Research Center for Biosciences and Health Technologies, Lisbon, Portugal
| |
Collapse
|
24
|
Harris SA, Harrison M, Hazell-Raine K, Wade C, Eapen V, Kohlhoff J. Patient navigation models for mental health of parents expecting or caring for an infant or young child: A systematic review. Infant Ment Health J 2023. [PMID: 37422890 DOI: 10.1002/imhj.22075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 04/07/2023] [Accepted: 05/11/2023] [Indexed: 07/11/2023]
Abstract
Patient navigation (PN) aims to improve timely access to healthcare by helping patients to "navigate" complex service provision landscapes. PN models have been applied in diverse healthcare settings including perinatal mental health (PMH). However, the practice models and implementation of PN programs vary widely, and their impact on engagement with PMH services has not been systematically investigated. This systematic narrative review study aimed to (1) identify and describe existing PMH PN models, (2) understand their effectiveness in improving service engagement and clinical outcomes, (3) review patient and provider perceptions, and (4) explore facilitators and barriers to program success. A systematic search of published articles/reports describing PMH PN programs/service delivery models targeting parents in the period from conception to 5 years postpartum was conducted. In total, 19 articles describing 13 programs were identified. The analysis yielded a number of commonalities and differences across program settings, target populations, and the scope of the navigator role. While there was promising evidence to support the clinical efficacy and impact on service utilization of PN programs for PMH, the current evidence base is sparse. Further research evaluating the efficacy of such services, and facilitators and barriers to their success, is warranted.
Collapse
Affiliation(s)
- Sophia A Harris
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Michelle Harrison
- Parenting Research Centre, Melbourne, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Karen Hazell-Raine
- Faculty of Health, Charles Darwin University, Darwin, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | | | - Valsamma Eapen
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
- South Western Sydney Local Health District, Liverpool, Australia
| | - Jane Kohlhoff
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| |
Collapse
|
25
|
Kohlhoff J, Harris SA, Lawson KD, Eapen V. ForWhen Australian perinatal and infant mental health navigation programme: evaluation protocol. BMJ Open 2023; 13:e070067. [PMID: 37277223 DOI: 10.1136/bmjopen-2022-070067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
INTRODUCTION Many parents and carers experience mental health challenges during pregnancy and early postpartum years, and there are cumulative shortfalls in the identification, follow-up, and treatment of those experiencing perinatal and infant mental health (PIMH) challenges. ForWhen is a new national navigation programme in Australia that aims to improve outcomes for families by supporting parents and carers to access PIMH services that best meet their needs. This paper presents the protocol of an evaluation of the ForWhen programme, to be conducted over the first 3 years of its implementation. The specific objectives of the evaluation include examining the characteristics of navigation service delivery, its implementation and clinical impact, and identifying potential moderators of change. METHODS AND ANALYSIS Utilising a mixed-methods design, this evaluation will incorporate three phases that reflect the stages of the programme life-cycle: (1) programme description, (2) implementation evaluation and (3) outcomes evaluation. The evaluation will use a mix of quantitative and qualitative data including deidentified routinely collected service data, participant observations, semistructured interviews, surveys and questionnaires, and a resource audit. DISCUSSION Evaluation findings will be used to inform the development of a refined clinical navigation model, identify barriers and facilitators to successful navigation programme implementation, examine the impact of the ForWhen programme on client clinical outcomes and health service utilisation, understand how the programme is/can be best embedded in the evolving service system, and assess the cost-effectiveness and sustainability of a national navigation programme in improving health outcomes for PIMH in Australia. ETHICS AND DISSEMINATION This research was approved by South Western Sydney Local Health District Human Research Ethics Committee (2021/ETH11611). This study was registered on the Australian New Zealand Clinical Trials Registry (ACTRN12622001443785). Results will be disseminated at conferences, in scientific journals, and in a final evaluation report.
Collapse
Affiliation(s)
- Jane Kohlhoff
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia
- Karitane Research Department, Karitane, Sydney, New South Wales, Australia
| | - Sophia A Harris
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Kenny D Lawson
- Western Sydney University, Sydney, New South Wales, Australia
| | - Valsamma Eapen
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia
- Academic Unit of Infant, Child & Adolescent Psychiatry Services (AUCS), South Western Sydney Local Health District, Sydney, New South Wales, Australia
- Ingham Institute, Sydney, New South Wales, Australia
| |
Collapse
|
26
|
Teggart K, Neil-Sztramko SE, Nadarajah A, Wang A, Moore C, Carter N, Adams J, Jain K, Petrie P, Alshaikhahmed A, Yugendranag S, Ganann R. Effectiveness of system navigation programs linking primary care with community-based health and social services: a systematic review. BMC Health Serv Res 2023; 23:450. [PMID: 37158878 PMCID: PMC10165767 DOI: 10.1186/s12913-023-09424-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 04/19/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Fragmented delivery of health and social services can impact access to high-quality, person-centred care. The goal of system navigation is to reduce barriers to healthcare access and improve the quality of care. However, the effectiveness of system navigation remains largely unknown. This systematic review aims to identify the effectiveness of system navigation programs linking primary care with community-based health and social services to improve patient, caregiver, and health system outcomes. METHODS Building on a previous scoping review, PsychInfo, EMBASE, CINAHL, MEDLINE, and Cochrane Clinical Trials Registry were searched for intervention studies published between January 2013 and August 2020. Eligible studies included system navigation or social prescription programs for adults, based in primary care settings. Two independent reviewers completed study selection, critical appraisal, and data extraction. RESULTS Twenty-one studies were included; studies had generally low to moderate risk of bias. System navigation models were lay person-led (n = 10), health professional-led (n = 4), team-based (n = 6), or self-navigation with lay support as needed (n = 1). Evidence from three studies (low risk of bias) suggests that team-based system navigation may result in slightly more appropriate health service utilization compared to baseline or usual care. Evidence from four studies (moderate risk of bias) suggests that either lay person-led or health professional-led system navigation models may improve patient experiences with quality of care compared to usual care. It is unclear whether system navigation models may improve patient-related outcomes (e.g., health-related quality of life, health behaviours). The evidence is very uncertain about the effect of system navigation programs on caregiver, cost-related, or social care outcomes. CONCLUSIONS There is variation in findings across system navigation models linking primary care with community-based health and social services. Team-based system navigation may result in slight improvements in health service utilization. Further research is needed to determine the effects on caregiver and cost-related outcomes.
Collapse
Affiliation(s)
- Kylie Teggart
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main St. W, Hamilton, ON, HSC 3N25L8S 4K1, Canada
| | - Sarah E Neil-Sztramko
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, 175 Longwood Rd S, Suite 210a, Hamilton, ON, L8P 0A1, Canada
| | - Abbira Nadarajah
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main St. W, Hamilton, ON, HSC 3N25L8S 4K1, Canada
| | - Amy Wang
- Department of Family Medicine, University of Alberta, 5-16 University Terrace, Edmonton, AB, T6G 2T4, Canada
| | - Caroline Moore
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main St. W, Hamilton, ON, HSC 3N25L8S 4K1, Canada
| | - Nancy Carter
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main St. W, Hamilton, ON, HSC 3N25L8S 4K1, Canada
| | - Janet Adams
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main St. W, Hamilton, ON, HSC 3N25L8S 4K1, Canada
| | - Kamal Jain
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main St. W, Hamilton, ON, HSC 3N25L8S 4K1, Canada
| | - Penelope Petrie
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main St. W, Hamilton, ON, HSC 3N25L8S 4K1, Canada
| | - Aref Alshaikhahmed
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main St. W, Hamilton, ON, HSC 3N25L8S 4K1, Canada
| | - Shreya Yugendranag
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main St. W, Hamilton, ON, HSC 3N25L8S 4K1, Canada
| | - Rebecca Ganann
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main St. W, Hamilton, ON, HSC 3N25L8S 4K1, Canada.
| |
Collapse
|
27
|
Schindel D, Gebert P, Frick J, Letsch A, Grittner U, Schenk L. Associations among navigational support and health care utilization and costs in patients with advanced cancer: An analysis based on administrative health insurance data. Cancer Med 2023; 12:8662-8675. [PMID: 36622058 PMCID: PMC10134282 DOI: 10.1002/cam4.5574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Fragmented and complex healthcare systems make it difficult to provide continuity of care for patients with advanced cancer near the end of life. Nurse-based cross-sectoral navigation support has the potential to increase patients' quality of life. The objective of this paper was to evaluate associations between navigation support and health care utilization, and the associated costs of care. METHODS The evaluation is based on claims data from 37 statutory health insurance funds. Non-randomized recruitment of the intervention group (IG) took place between 2018 and 2019 in four German hospitals. The comparison group (CG) was defined ex post. It comprises nonparticipating clients of the involved health insurance funds matched on age, gender, and diagnosis in a 1:4 ratio to the IG. Healthcare resource utilization was compared using incident rate ratios (IRRs) based on negative binomial regression models. Linear mixed models were performed to compare differences in lengths of hospital stays and costs between groups. RESULTS A total of 717 patients were included (IG: 149, CG: 568). IG patients showed shorter average lengths of hospital stays (IG: 11 days [95% CI: 10, 13] vs. CG: 15 days [95% CI: 14, 16], p < 0.001). In the IG, 21% fewer medications were prescribed and there were on average 15% fewer outpatient doctor contacts per month. Average billed costs in the IG were 23% lower than in the CG (IG: 6754 EUR [95% CI: 5702, 8000] vs. CG: 8816 EUR [95% CI: 8153, 9533], p < 0.001). CONCLUSIONS The intervention was associated with decreased costs mainly as a result of a non-intended navigation effect. The social care nurses had navigated patients within the hospital early, needs-oriented and effectively but interpreted their function less cross-sectorally. Linkage of hospital-based navigators with the outpatient care sector needs further exploration.
Collapse
Affiliation(s)
- Daniel Schindel
- Institute of Medical Sociology and Rehabilitation Science, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Pimrapat Gebert
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Johann Frick
- Institute of Medical Sociology and Rehabilitation Science, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Anne Letsch
- Department of Medicine II, Hematology and Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Ulrike Grittner
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Liane Schenk
- Institute of Medical Sociology and Rehabilitation Science, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| |
Collapse
|
28
|
Kokorelias KM, Lee TSJ, Bayley M, Seto E, Toulany A, Nelson MLA, Dimitropoulos G, Penner M, Simpson R, Munce SEP. "I Have Eight Different Files at Eight Different Places": Perspectives of Youths and Their Family Caregivers on Transitioning from Pediatric to Adult Rehabilitation and Community Services. J Clin Med 2023; 12:jcm12041693. [PMID: 36836228 PMCID: PMC9960001 DOI: 10.3390/jcm12041693] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/22/2023] Open
Abstract
INTRODUCTION The number of young adults (youth) living with childhood-onset disabilities, and requiring transitional support to adult community and rehabilitation services, is increasing. We explored facilitators and barriers to accessing and sustaining community and rehabilitation services during the transition from pediatric to adult care. METHODS A qualitative descriptive study was conducted in Ontario, Canada. Data were collected through interviews with youth (n = 11) and family caregivers (n = 7). The data were coded and analyzed using thematic analysis. RESULTS Youth and caregivers face many types of transitions from pediatric to adult community and rehabilitation services, e.g., those related to education, living arrangements, and employment. This transition is marked by feelings of isolation. Supportive social networks, continuity of care (i.e., same care providers), and advocacy all contribute to positive experiences. Lack of knowledge about resources, changing parental involvement without preparation, and a lack of system responses to evolving needs were barriers to positive transitions. Financial circumstances were described as either a barrier or facilitator to service access. CONCLUSIONS This study demonstrated that continuity of care, support from providers, and social networks all contribute markedly to the positive experience of transitioning from pediatric to adult services for individuals with childhood-onset disabilities and family caregivers. Future transitional interventions should incorporate these considerations.
Collapse
Affiliation(s)
- Kristina M. Kokorelias
- Department of Medicine, Sinai Health System and University Health Network, Toronto, ON, Canada
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, ON M5G 2A2, Canada
- Department of Occupational Sciences and Occupational Therapy, Temetry Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Tin-Suet Joan Lee
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, ON M5G 2A2, Canada
| | - Mark Bayley
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, ON M5G 2A2, Canada
- Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada
| | - Emily Seto
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Center for Digital Therapeutics, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Alene Toulany
- Department of Adolescent Medicine, the Hospital for Sick Children, Toronto, ON, Canada
| | - Michelle L. A. Nelson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - Gina Dimitropoulos
- Faculty of Social Work, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Melanie Penner
- Department of Pediatrics, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, Toronto, ON, Canada
| | - Robert Simpson
- St. John’s Rehab Research Program at Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, North York, ON M2M 2G1, Canada
| | - Sarah E. P. Munce
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, ON M5G 2A2, Canada
- Department of Occupational Sciences and Occupational Therapy, Temetry Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Pediatrics, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temetry Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Correspondence:
| |
Collapse
|
29
|
Anthonisen G, Luke A, MacNeill L, MacNeill AL, Goudreau A, Doucet S. Patient navigation programs for people with dementia, their caregivers, and members of the care team: a scoping review. JBI Evid Synth 2023; 21:281-325. [PMID: 36449660 PMCID: PMC10578521 DOI: 10.11124/jbies-22-00024] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVE The main objective of this review was to map the literature on the characteristics of patient navigation programs for people with dementia, their caregivers, and members of the care team across all settings. The secondary objective was to map the literature on the barriers and facilitators for implementing and delivering such patient navigation programs. INTRODUCTION People with dementia have individualized needs that change according to the stage of their condition. They often face fragmented and uncoordinated care when seeking support to address these needs. Patient navigation may be one way to help people with dementia access better care. Patient navigation is a model of care that aims to guide people through the health care system, matching their unmet needs to appropriate resources, services, and programs. Organizing the available information on this topic will present a clearer picture of how patient navigation programs work. INCLUSION CRITERIA This review focused on the characteristics of patient navigation programs for people living with dementia, their caregivers, and the members of the care team. It excluded programs not explicitly focused on dementia. It included patient navigation across all settings, delivered in all formats, and administered by all types of navigators if the programs aligned with this review's definition of patient navigation. This review excluded case management programs. METHODS This review was conducted in accordance with JBI methodology for scoping reviews. MEDLINE, CINAHL, APA PsycINFO, Embase, and ProQuest Nursing and Allied Health databases were searched for published full-text articles. A gray literature search was also conducted. Two independent reviewers screened articles for relevance against the inclusion criteria. The results are presented in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram, and the extracted data are presented narratively and in tabular format. RESULTS Thirty-nine articles describing 20 programs were included in this review. The majority of these articles were published between 2015 and 2020, and based out of the United States. The types of sources included randomized controlled trials, quasi-experimental studies, and qualitative exploratory studies, among others. All programs provided some form of referral or linkage to other services or resources. Most dementia navigation programs included an interdisciplinary team, and most programs were community-based. There was no consistent patient navigator title or standard delivery method. Commonly reported barriers to implementing and delivering these programs were navigator burnout and a lack of coordination between stakeholders. Commonly reported facilitators were collaboration, communication, and formal partnerships between key stakeholders, as well as accessible and flexible program delivery models. CONCLUSIONS This review demonstrates variety and flexibility in the types of services patient navigation programs provided, as well as in the modes of service delivery and in navigator title. This information may be useful for individuals and organizations looking to implement their own programs in the future. It also provides a framework for future systematic reviews that seek to evaluate the effectiveness or efficacy of dementia navigation programs.
Collapse
Affiliation(s)
- Grailing Anthonisen
- Centre for Research in Integrated Care, University of New Brunswick, Saint John, NB, Canada
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, NB, Canada
| | - Alison Luke
- Centre for Research in Integrated Care, University of New Brunswick, Saint John, NB, Canada
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, NB, Canada
- The University of New Brunswick (UNB) Saint John Collaboration for Evidence-Informed Healthcare: A JBI Centre of Excellence, Saint John, NB, Canada
| | - Lillian MacNeill
- Centre for Research in Integrated Care, University of New Brunswick, Saint John, NB, Canada
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, NB, Canada
| | - A. Luke MacNeill
- Centre for Research in Integrated Care, University of New Brunswick, Saint John, NB, Canada
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, NB, Canada
| | - Alex Goudreau
- The University of New Brunswick (UNB) Saint John Collaboration for Evidence-Informed Healthcare: A JBI Centre of Excellence, Saint John, NB, Canada
- University of New Brunswick Libraries, Saint John, NB, Canada
| | - Shelley Doucet
- Centre for Research in Integrated Care, University of New Brunswick, Saint John, NB, Canada
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, NB, Canada
- The University of New Brunswick (UNB) Saint John Collaboration for Evidence-Informed Healthcare: A JBI Centre of Excellence, Saint John, NB, Canada
| |
Collapse
|
30
|
M Kokorelias K, L Sheppard C, L Hitzig S. The role of patient navigation in supporting low-income older adults in their housing needs during hospital to home transitions: A qualitative descriptive study from Ontario, Canada. INTERNATIONAL JOURNAL OF CARE COORDINATION 2023. [DOI: 10.1177/20534345231151209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Introduction Housing is an important determinant of health. Little research has explored hospital and community agency staff perspectives on how to support the housing needs of low-income older adults. Therefore, this paper examines the challenges associated with supporting low-income seniors as they transition from hospital to home and explores what role, if any, patient navigation models of care could have in addressing housing needs. Methods A thematic secondary analysis that triangulated data from two qualitative studies was used. In total, interviews and/or focus groups with 109 hospital and community care workers were re-analyzed, applying a new interpretive lens to the data to reveal new insights. Data were collected in Ontario, Canada. Results Participants described how low-income older adults have increasing complex care needs that influence their housing, but housing supports are limited and difficult to navigate. Participants believed further support was needed and suggested that a housing-specific patient navigation model of care may be beneficial, but difficult to implement due to the limitations of existing services. Discussion Our findings provide a unique perspective on the challenges hospital and community staff face in caring for older adults with housing needs. Patient navigation with a focus on housing may support these older adults. Further work needs to be undertaken to better understand how to best implement sustainable housing patient navigation models of care.
Collapse
Affiliation(s)
- Kristina M Kokorelias
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Christine L Sheppard
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Sander L Hitzig
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
31
|
M. Kokorelias K, Liu Z, L. Hitzig S. Understanding implementation characteristics in navigation programs for persons living with dementia and their caregivers: A scoping review. INTERNATIONAL JOURNAL OF CARE COORDINATION 2023. [DOI: 10.1177/20534345231151208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Introduction Dementia care is often fragmented and un-coordinated. As the number of individuals living with dementia increases worldwide, navigation programs are a way to help counter difficulties with navigating and accessing services by better integrating care for individuals with dementia and their family caregivers. While navigation programs are increasingly being used, it is not clear how to best implement such programs in North America and abroad. Methods Following Arskey and O’Malley's (2006) scoping review methodology and theoretically informed by the Consolidated Framework for Implementation Research, this paper explored existing navigational programs used in dementia care to identify factors to consider when implementing these programs across different settings. Results Twenty-two articles were included in this review. Our findings suggest that there is a high degree of variability with how navigation programs are being delivered and no clearly established or standardized protocol to implement such programs. Barriers and facilitators to implementation were identified as they relate to (1) Complexity (Intervention Characteristics); (2) Patient and Caregiver Needs (Outer Setting); (3) External Policies (Outer Setting); (4) Available Resources (Inner Setting) (5) Communication (Inner Setting); (6) Culture (Inner Setting); (7) Leadership Engagement (Inner Setting); (8) Knowledge and Beliefs ( Characteristics of Individuals); (9) Champions (Process) and (10) Evaluation (Process). Discussion Combined, the findings from this review provide suggestions for implementing navigation in the context of dementia care and suggest several pragmatic considerations (e.g. available resources) when implementing new navigation programs.
Collapse
Affiliation(s)
- Kristina M. Kokorelias
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Zoe Liu
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Queen's University, Kingston, Ontario, Canada
| | - Sander L. Hitzig
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
32
|
Kokorelias KM, Markoulakis R, Hitzig SL. Considering a Need for Dementia-Specific, Family-Centered Patient Navigation in Canada. J Appl Gerontol 2023; 42:19-27. [PMID: 36503280 DOI: 10.1177/07334648221125781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Patient navigation has been proposed as a novel family-centered, integrated care model to address the care needs of persons living with dementia and their family caregivers by helping them navigate the complex range of dementia services offered in hospital and community settings. A key informant qualitative descriptive study explored the perspectives of 48 healthcare professionals to explore the need for dementia-specific patient navigation. Data were analyzed thematically. We identified one overarching theme: "Variability in the Need for Illness-Specific Patient Navigation" and five themes that highlight considerations when providing navigation to individuals with dementia: (1) Taking Part in Ongoing Training, (2) Addressing Stigma, (3) Focusing on Quality of Life, (4) Defining Home, and (5) A Continuous Process of Support. These themes provide preliminary insights into the conceptual differences about the need for illness-specific patient navigation and the areas within patient navigation where healthcare professionals are encouraged to find consensus.
Collapse
Affiliation(s)
- Kristina M Kokorelias
- St John's Rehab Research Program, Sunnybrook Health Sciences Centre, 574553Sunnybrook Research Institute, Toronto, ON, Canada
| | - Roula Markoulakis
- Family Navigation Project, 574553Sunnybrook Research Institute, Toronto, ON, Canada.,Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sander L Hitzig
- St John's Rehab Research Program, Sunnybrook Health Sciences Centre, 574553Sunnybrook Research Institute, Toronto, ON, Canada.,Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Temerty Faculty of Medicine, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada to, Rehabilitation Sciences Institute, Temerty Faculty of Medicine University of Toronto, Toronto, ON, Canada
| |
Collapse
|
33
|
Mullen JN, Levitt A, Markoulakis R. Supporting Individuals with Mental Health and/or Addictions Issues Through Patient Navigation: A Scoping Review. Community Ment Health J 2023; 59:35-56. [PMID: 35648257 DOI: 10.1007/s10597-022-00982-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 05/01/2022] [Indexed: 01/07/2023]
Abstract
Pathways through the mental health care system can be complex and laden with barriers that prevent individuals from finding the most appropriate care. Navigation has been proposed as a solution for improving access to and transition through complex health care systems. While several MHA navigation programs have emerged in the past decade, no study has explored the core themes of MHA navigation, which was the goal of the current review. A scoping review was conducted; the search yielded 11,525 unique results, of which 26 were entered into extraction and subsequent descriptive and thematic analysis. Barrier reduction, client-centered support, and integrated care emerged as the distinct themes underlying MHA services, and overall, navigation significantly improved outcomes for individuals experiencing MHA issues. These findings may support evidence-based implementation of navigation services and point to a need for increased exploration and reporting of MHA navigation outcomes in the literature.
Collapse
Affiliation(s)
- Jennifer N Mullen
- Family Navigation Project, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Anthony Levitt
- Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Roula Markoulakis
- Family Navigation Project, Sunnybrook Research Institute, Toronto, ON, Canada.
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
34
|
Chen W, Chung JOK, Lam KKW, Molassiotis A. End-of-life communication strategies for healthcare professionals: A scoping review. Palliat Med 2023; 37:61-74. [PMID: 36349371 DOI: 10.1177/02692163221133670] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Timely and effective communication about end-of-life issues, including conversations about prognosis and goals of care, are extremely beneficial to terminally ill patients and their families. However, given the context, healthcare professionals may find it challenging to initiate and facilitate such conversations. Hence, it is critical to improving the available communication strategies to enhance end-of-life communication practices. AIM To summarise the end-of-life communication strategies recommended for healthcare professionals, identify research gaps and inform future research. DESIGN A scoping review performed in accordance with the Arksey and O'Malley framework. DATA SOURCES A literature search was conducted between January 1990 and January 2022 using PubMed, CINAHL, Embase, PsycINFO, Web of Science, Scopus, Cochrane Library and China National Knowledge Infrastructure databases and Google, Google Scholar and ProQuest Dissertations & Theses Global. Studies that described recommended end-of-life communication strategies for healthcare professionals were included. RESULTS Fifty-nine documents were included. Seven themes of communication strategies were found: (a) preparation; (b) exploration and assessment; (c) family involvement; (d) provision and tailoring of information; (e) empathic emotional responses; (f) reframing and revisiting the goals of care; and (g) conversation closure. CONCLUSIONS The themes of communication strategies found in this review provide a framework to integrally promote end-of-life communication. Our results will help inform healthcare professionals, thereby promoting the development of specialised training and education on end-of-life communication.
Collapse
Affiliation(s)
- Weilin Chen
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Joyce Oi Kwan Chung
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Katherine Ka Wai Lam
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Alex Molassiotis
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China.,Health and Social Care Research Centre, University of Derby, Derby, UK
| |
Collapse
|
35
|
Stretton C, Chan WY, Wepa D. Demystifying Case Management in Aotearoa New Zealand: A Scoping and Mapping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:784. [PMID: 36613105 PMCID: PMC9819615 DOI: 10.3390/ijerph20010784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 12/14/2022] [Accepted: 12/28/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Community-based case managers in health have been compared to glue which holds the dynamic needs of clients to a disjointed range of health and social services. However, case manager roles are difficult to understand due to poorly defined roles, confusing terminology, and low visibility in New Zealand. AIM This review aims to map the landscape of case management work to advance workforce planning by clarifying the jobs, roles, and relationships of case managers in Aotearoa New Zealand (NZ). METHODS Our scoping and mapping review includes peer-reviewed articles, grey literature sources, and interview data from 15 case managers. Data was charted iteratively until convergent patterns emerged and distinctive roles identified. RESULTS A rich and diverse body of literature describing and evaluating case management work in NZ (n = 148) is uncovered with at least 38 different job titles recorded. 18 distinctive roles are further analyzed with sufficient data to explore the research question. Social ecology maps highlight diverse interprofessional and intersectoral relationships. CONCLUSIONS Significant innovation and adaptations are evident in this field, particularly in the last five years. Case managers also known as health navigators, play a pivotal but often undervalued role in NZ health care, through their interprofessional and intersectoral relationships. Their work is often unrecognised which impedes workforce development and the promotion of person-centered and integrated health care.
Collapse
Affiliation(s)
- Caroline Stretton
- Centre for Person Centred Research (PCR), School of Clinical Sciences, Faculty of Health and Environmental Sciences, AUT University, North Shore, Auckland 1142, New Zealand
- School of Public Health and Interdisciplinary Studies, Faculty of Health and Environmental Sciences, AUT University, North Shore, Auckland 1142, New Zealand
| | - Wei-Yen Chan
- School of Public Health and Interdisciplinary Studies, Faculty of Health and Environmental Sciences, AUT University, North Shore, Auckland 1142, New Zealand
| | - Dianne Wepa
- School of Public Health and Interdisciplinary Studies, Faculty of Health and Environmental Sciences, AUT University, North Shore, Auckland 1142, New Zealand
- School of Nursing & Healthcare Leadership, Faculty of Health Studies, University of Bradford, Bradford BD7 1DP, UK
- Mental Health and Suicide Prevention Research and Education Group, Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
| |
Collapse
|
36
|
Fleming MD, Safaeinili N, Knox M, Hernandez E, Esteban EE, Sarkar U, Brewster AL. Conceptualizing the effective mechanisms of a social needs case management program shown to reduce hospital use: a qualitative study. BMC Health Serv Res 2022; 22:1585. [PMID: 36572882 PMCID: PMC9791730 DOI: 10.1186/s12913-022-08979-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/16/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Social needs case management programs are a strategy to coordinate social and medical care for high-risk patients. Despite widespread interest in social needs case management, not all interventions have shown effectiveness. A lack of evidence about the mechanisms through which these complex interventions benefit patients inhibits effective translation to new settings. The CommunityConnect social needs case management program in Contra Costa County, California recently demonstrated an ability to reduce inpatient hospital admissions by 11% in a randomized study. We sought to characterize the mechanisms through which the Community Connect social needs case management program was effective in helping patients access needed medical and social services and avoid hospitalization. An in-depth understanding of how this intervention worked can support effective replication elsewhere. METHODS Using a case study design, we conducted semi-structured, qualitative interviews with case managers (n = 30) and patients enrolled in social needs case management (n = 31), along with field observations of patient visits (n = 31). Two researchers coded all interview transcripts and observation fieldnotes. Analysis focused on program elements identified by patients and staff as important to effectiveness. RESULTS Our analyses uncovered three primary mechanisms through which case management impacted patient access to needed medical and social services: [1] Psychosocial work, defined as interpersonal and emotional support provided through the case manager-patient relationship, [2] System mediation work to navigate systems, coordinate resources, and communicate information and [3] Addressing social needs, or working to directly mitigate the impact of social conditions on patient health. CONCLUSIONS These findings highlight that the system mediation tasks which are the focus of many social needs assistance interventions offered by health care systems may be necessary but insufficient. Psychosocial support and direct assistance with social needs, enabled by a relationship-focused program, may also be necessary for effectiveness.
Collapse
Affiliation(s)
- Mark D. Fleming
- grid.47840.3f0000 0001 2181 7878University of California, Berkeley, School of Public Health—Berkeley, California, USA
| | - Nadia Safaeinili
- grid.47840.3f0000 0001 2181 7878University of California, Berkeley, School of Public Health—Berkeley, California, USA
| | - Margae Knox
- grid.47840.3f0000 0001 2181 7878University of California, Berkeley, School of Public Health—Berkeley, California, USA
| | - Elizabeth Hernandez
- grid.421504.60000 0004 0442 6009Contra Costa Health Services, Contra Costa County—Concord, California, USA
| | - Emily E. Esteban
- grid.421504.60000 0004 0442 6009Contra Costa Health Services, Contra Costa County—Concord, California, USA
| | - Urmimala Sarkar
- grid.267103.10000 0004 0461 8879Department of Medicine—San Francisco, University of California, San Francisco, California, USA
| | - Amanda L. Brewster
- grid.47840.3f0000 0001 2181 7878University of California, Berkeley, School of Public Health—Berkeley, California, USA
| |
Collapse
|
37
|
Doucet S, Luke A, Anthonisen G. Hospital-based patient navigation programs for patients who experience injury-related trauma and their caregivers: a scoping review. BMJ Open 2022; 12:e066260. [PMID: 36572494 PMCID: PMC9806040 DOI: 10.1136/bmjopen-2022-066260] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE This review's objective is to map the literature on the characteristics, impact, barriers and facilitators of hospital-based patient navigation programmes that support patients who experience injury-related trauma and their caregivers. Patients who experience injury-related trauma frequently require support from multiple care teams and face many challenges to care, both in hospital and when transitioning across settings and services. Patient navigation can improve their care. DESIGN This review is conducted according to JBI methodology for scoping reviews. The initial database search took place on 6 June 2021 and the grey literature search took place between September and October 2021. The results are presented in a Preferred Reporting Items for Systematic Reviews and Meta-analyses for Scoping Reviews flow diagram. SETTING This review considered materials where the patient navigation programmes were delivered in hospital settings. There was no geographical limit to this study. PARTICIPANTS This review focused on hospital-based patient navigation programmes for patients who experience injury-related trauma and/or their caregivers. RESULTS This review captured 11 records that describe 10 programmes. All programmes were based in the USA. Most programmes provided education, care coordination, discharge planning, and referrals to resources, services, and programmes to assist patients and/or their families in the hospital or the community. Half the programmes were based in level 1 trauma centres. Common impacts included decreases in readmission rates and increases in satisfaction rates. Barriers included difficulty recruiting or enrolling patients with short hospital stays and hospital administrators' and healthcare providers' lack of understanding of the navigator role. Navigator background, either professional or experiential, was identified as a facilitator, as was flexibility in programme delivery and communication methods. CONCLUSIONS Eleven records show a small but distinct sample. Reported characteristics, impact, barriers and facilitators were consistent with findings from other patient navigation studies. The results can inform the development and implementation of similar programmes in trauma centres and support changes in policy to improve the delivery of care.
Collapse
Affiliation(s)
- Shelley Doucet
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
- University of New Brunswick (UNB) Saint John Collaboration for Evidence-Informed Healthcare: A JBI Centre of Excellence, Saint John, New Brunswick, Canada
- Centre for Research in Integrated Care, Saint John, New Brunswick, Canada
| | - Alison Luke
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
- University of New Brunswick (UNB) Saint John Collaboration for Evidence-Informed Healthcare: A JBI Centre of Excellence, Saint John, New Brunswick, Canada
- Centre for Research in Integrated Care, Saint John, New Brunswick, Canada
| | - Grailing Anthonisen
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
- Centre for Research in Integrated Care, Saint John, New Brunswick, Canada
| |
Collapse
|
38
|
Traynor SM, Schmidt RD, Gooden LK, Matheson T, Haynes L, Rodriguez A, Mugavero M, Jacobs P, Mandler R, Del Rio C, Carrico AW, Horigian VE, Metsch LR, Feaster DJ. Differential Effects of Patient Navigation across Latent Profiles of Barriers to Care among People Living with HIV and Comorbid Conditions. J Clin Med 2022; 12:114. [PMID: 36614917 PMCID: PMC9820894 DOI: 10.3390/jcm12010114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/29/2022] [Accepted: 12/10/2022] [Indexed: 12/28/2022] Open
Abstract
Engaging people living with HIV who report substance use (PLWH-SU) in care is essential to HIV medical management and prevention of new HIV infections. Factors associated with poor engagement in HIV care include a combination of syndemic psychosocial factors, mental and physical comorbidities, and structural barriers to healthcare utilization. Patient navigation (PN) is designed to reduce barriers to care, but its effectiveness among PLWH-SU remains unclear. We analyzed data from NIDA Clinical Trials Network's CTN-0049, a three-arm randomized controlled trial testing the effect of a 6-month PN with and without contingency management (CM), on engagement in HIV care and viral suppression among PLWH-SU (n = 801). Latent profile analysis was used to identify subgroups of individuals' experiences to 23 barriers to care. The effects of PN on engagement in care and viral suppression were compared across latent profiles. Three latent profiles of barriers to care were identified. The results revealed that PN interventions are likely to be most effective for PLWH-SU with fewer, less severe healthcare barriers. Special attention should be given to individuals with a history of abuse, intimate partner violence, and discrimination, as they may be less likely to benefit from PN alone and require additional interventions.
Collapse
Affiliation(s)
- Sharleen M. Traynor
- Clinical Trials Research Associate Program, Durham Technical Community College, Durham, NC 27703, USA
| | - Renae D. Schmidt
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 Northwest 14th Street, Miami, FL 33136, USA
| | - Lauren K. Gooden
- Sociomedical Sciences Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA
| | - Tim Matheson
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, CA 94102, USA
| | - Louise Haynes
- Department of Psychiatry and Behavioral Science, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Allan Rodriguez
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Michael Mugavero
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, 1900 University Blvd # 229, Birmingham, AL 35233, USA
| | - Petra Jacobs
- Center for Clinical Trials Network, National Institute on Drug Abuse, Rockville, MD 20892, USA
| | - Raul Mandler
- Division of Therapeutics and Medical Consequences, National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD 20892, USA
| | - Carlos Del Rio
- Division of Infectious Diseases, Emory University, Atlanta, GA 30322, USA
| | - Adam W. Carrico
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 Northwest 14th Street, Miami, FL 33136, USA
| | - Viviana E. Horigian
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 Northwest 14th Street, Miami, FL 33136, USA
| | - Lisa R. Metsch
- Sociomedical Sciences Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA
| | - Daniel J. Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 Northwest 14th Street, Miami, FL 33136, USA
| |
Collapse
|
39
|
Shahidullah JD, Petts R, Broder-Fingert S. Toward Antiracism Pediatric Practice: The Role of System Navigation in the Medical Home. J Dev Behav Pediatr 2022; 43:537-539. [PMID: 36115018 DOI: 10.1097/dbp.0000000000001131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/01/2022] [Indexed: 11/26/2022]
Affiliation(s)
| | - Rachel Petts
- Fairleigh Dickinson University, Teaneck, NJ; and
| | | |
Collapse
|
40
|
Kokorelias KM, Gould S, DasGupta T, Cass D, Hitzig SL. Assessing readiness to implement patient navigator programs in Toronto, Canada. J Eval Clin Pract 2022; 28:550-557. [PMID: 34664339 DOI: 10.1111/jep.13630] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/14/2021] [Accepted: 09/21/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To explore factors influencing the implementation of patient navigator programs within a hospital for seniors with complex care needs. METHODS A qualitative descriptive design using in-depth interviews was conducted. Participant interviews were conducted in Toronto, Ontario between September 2020 and February 2021. Data were analysed using thematic analysis. RESULTS Thirty-five semi-structured interviews were conducted with 38 participants from a large urban hospital (n = 21) and community healthcare organizations (n = 17), including organizational leaders, and acute care and rehabilitation providers. Follow-up interviews occurred with 16 participants (7 from the community and nine from the hospital). This study identified five key factors influencing organizational readiness for successful implementation of a patient navigator program for seniors with complex conditions, which included: (a) vision from senior leadership, (b) technological infrastructure, (c) existing hospital-community partnerships, (d) well-established process for referrals, and (e) staff capacity. The overarching theme of communication was also identified. CONCLUSIONS The findings of this study provide a better understanding of hospital and community professionals' needs and challenges when implementing patient navigator programs for seniors with complex care conditions. There are a number of factors that influence an organization's readiness for program uptake and delivery, with the need for clear communication being paramount. Further research to test the effects of readiness on successful implementation outcomes is warranted.
Collapse
Affiliation(s)
- Kristina M Kokorelias
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Sarah Gould
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Tracey DasGupta
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Dan Cass
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sander L Hitzig
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
41
|
Frick J, Gebert P, Grittner U, Letsch A, Schindel D, Schenk L. Identifying and handling unbalanced baseline characteristics in a non-randomized, controlled, multicenter social care nurse intervention study for patients in advanced stages of cancer. BMC Cancer 2022; 22:560. [PMID: 35585571 PMCID: PMC9118792 DOI: 10.1186/s12885-022-09646-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 05/06/2022] [Indexed: 12/13/2022] Open
Abstract
Purpose Given the psychosocial burdens patients in advanced stages of cancer face, innovative care concepts are needed. At the same time, such vulnerable patient groups are difficult to reach for participation in intervention studies and randomized patient inclusion may not be feasible. This article aims to identify systematic biases respectively selection effects occurring during the recruitment phase and to discuss their potential causes based on a non-randomized, multicenter intervention study with patients in advanced stages of cancer. Methods Patients diagnosed with at least one of 16 predefined cancers were recruited at four hospitals in three German cities. The effect of social care nurses’ continuous involvement in acute oncology wards was measured by health-related quality of life (EORTC QLQ-C30), information and participation preferences, decisional conflicts, doctor-patient communication, health literacy and symptom perception. Absolute standardized mean difference was calculated as a standardized effect size to test baseline characteristics balance between the intervention and control groups. Results The study enrolled 362 patients, 150 in the intervention and 212 in the control group. Except for gender, both groups differed in relevant socio-demographic characteristics, e.g. regarding age and educational background. With respect to the distribution of diagnoses, the intervention group showed a higher symptom burden than the control group. Moreover, the control group reported better quality of life at baseline compared to the intervention group (52.6 points (SD 21.7); 47.8 points (SD 22.0), ASMD = 0.218, p = 0.044). Conclusion Overall, the intervention group showed more social and health vulnerability than the control group. Among other factors, the wide range of diagnoses included and structural variation between the recruiting clinics increased the risk for bias. We recommend a close, continuous monitoring of relevant social and health-related characteristics during the recruitment phase as well as the use of appropriate statistical analysis strategies for adjustment, such as propensity score methods. Trial registration: German Clinical Trials Register (DRKS-ID: DRKS00013640); registered on 29th December 2017. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09646-6.
Collapse
Affiliation(s)
- Johann Frick
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany
| | - Pimrapat Gebert
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Biometry and Clinical Epidemiology, Charitéplatz 1, 10117, Berlin, Germany.,Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, 10178, Berlin, Germany
| | - Ulrike Grittner
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Biometry and Clinical Epidemiology, Charitéplatz 1, 10117, Berlin, Germany.,Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, 10178, Berlin, Germany
| | - Anne Letsch
- Department of Medicine II, Hematology and Oncology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité Comprehensive Cancer Center, Charitéplatz 1, 10117, Berlin, Germany
| | - Daniel Schindel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany.
| | - Liane Schenk
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany
| |
Collapse
|
42
|
Doucet S, Luke A, Anthonisen G, Witherspoon R, MacNeill AL, MacNeill L, Kelly KJ, Fearon T. Hospital-based patient navigation programmes for patients who experience injury-related trauma and their caregivers: a scoping review protocol. BMJ Open 2022; 12:e055750. [PMID: 35459669 PMCID: PMC9036420 DOI: 10.1136/bmjopen-2021-055750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Patients who experience injury-related trauma tend to have complex care needs and often require support from many different care providers. Many patients experience gaps in care while in the hospital and during transitions in care. Providing access to integrated care can improve outcomes for these patients. Patient navigation is one approach to improving the integration of care and proactively supporting patients and their caregivers as they navigate the healthcare system. The objective of this scoping review is to map the literature on the characteristics and impact of hospital-based patient navigation programmes that support patients who experience injury-related trauma and their caregivers. METHODS AND ANALYSIS This review will be conducted in accordance with Joanna Briggs Institute methodology for scoping reviews. The review will include primary research studies, unpublished studies and evaluation reports related to patient navigation programmes for injury-related trauma in hospital settings. The databases to be searched will include CINAHL (EBSCO), EMBASE (Elsevier), ProQuest Nursing & Allied Health, PsycINFO (EBSCO) and MEDLINE (Ovid). Two independent reviewers will screen articles for relevance against the inclusion criteria. Results will be presented in a Preferred Reporting Items for Systematic Reviews and Meta-analyses for Scoping Reviews (PRISMA-ScR) flow diagram and follow the PRISMA-ScR checklist. The extracted data will be presented both tabularly and narratively. ETHICS AND DISSEMINATION Ethics approval is not required, as the scoping review will synthesise information from publicly available material. To disseminate the findings of this review, the authors will submit the results for publication in a medical or health sciences journal, present at relevant conferences and use other knowledge translation strategies to reach diverse stakeholders (eg, host webinars, share infographics).
Collapse
Affiliation(s)
- Shelley Doucet
- Centre for Research in Integrated Care, University of New Brunswick, Saint John, New Brunswick, Canada
- Department of Nursing and Health Sciences, University of New Brunswick Saint John, Saint John, New Brunswick, Canada
- University of New Brunswick (UNB) Saint John Collaboration for Evidence-Informed Healthcare: A JBI Centre of Excellence, Saint John, New Brunswick, Canada
| | - Alison Luke
- Centre for Research in Integrated Care, University of New Brunswick, Saint John, New Brunswick, Canada
- Department of Nursing and Health Sciences, University of New Brunswick Saint John, Saint John, New Brunswick, Canada
- University of New Brunswick (UNB) Saint John Collaboration for Evidence-Informed Healthcare: A JBI Centre of Excellence, Saint John, New Brunswick, Canada
| | - Grailing Anthonisen
- Centre for Research in Integrated Care, University of New Brunswick, Saint John, New Brunswick, Canada
- Department of Nursing and Health Sciences, University of New Brunswick Saint John, Saint John, New Brunswick, Canada
| | - Richelle Witherspoon
- Centre for Research in Integrated Care, University of New Brunswick, Saint John, New Brunswick, Canada
- University of New Brunswick (UNB) Saint John Collaboration for Evidence-Informed Healthcare: A JBI Centre of Excellence, Saint John, New Brunswick, Canada
- University of New Brunswick Libraries, University of New Brunswick Fredericton, Fredericton, New Brunswick, Canada
| | - A Luke MacNeill
- Centre for Research in Integrated Care, University of New Brunswick, Saint John, New Brunswick, Canada
- Department of Nursing and Health Sciences, University of New Brunswick Saint John, Saint John, New Brunswick, Canada
| | - Lillian MacNeill
- Centre for Research in Integrated Care, University of New Brunswick, Saint John, New Brunswick, Canada
- Department of Nursing and Health Sciences, University of New Brunswick Saint John, Saint John, New Brunswick, Canada
| | - Katherine J Kelly
- Centre for Research in Integrated Care, University of New Brunswick, Saint John, New Brunswick, Canada
- Applied Human Sciences, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Taylor Fearon
- Centre for Research in Integrated Care, University of New Brunswick, Saint John, New Brunswick, Canada
- Department of Nursing and Health Sciences, University of New Brunswick Saint John, Saint John, New Brunswick, Canada
| |
Collapse
|
43
|
Gonçalves I, Mendes DA, Caldeira S, Jesus E, Nunes E. Nurse‐led care management models for patients with multimorbidity in hospital settings: a scoping review. J Nurs Manag 2022; 30:1960-1973. [DOI: 10.1111/jonm.13621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/13/2022] [Accepted: 04/05/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Isabel Gonçalves
- Universidade Católica Portuguesa Institute of Health Sciences, Centre for Interdisciplinary Research in Health Portugal
| | | | - Sílvia Caldeira
- Universidade Católica Portuguesa Institute of Health Sciences, Centre for Interdisciplinary Research in Health Portugal
| | - Elvio Jesus
- Universidade Católica Portuguesa Institute of Health Sciences, Centre for Interdisciplinary Research in Health Portugal
| | - Elisabete Nunes
- Universidade Católica Portuguesa Institute of Health Sciences, Centre for Interdisciplinary Research in Health Portugal
| |
Collapse
|
44
|
Cadel L, Kuluski K, Everall AC, Guilcher SJT. Recommendations made by patients, caregivers, providers, and decision-makers to improve transitions in care for older adults with hip fracture: a qualitative study in Ontario, Canada. BMC Geriatr 2022; 22:291. [PMID: 35392830 PMCID: PMC8988316 DOI: 10.1186/s12877-022-02943-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/14/2022] [Indexed: 12/02/2022] Open
Abstract
Background Older adults frequently experience fall-related injuries, including hip fractures. Following a hip fracture, patients receive care across a number of settings and from multiple different providers. Transitions between providers and across settings have been noted as a vulnerable time, with potentially negative impacts. Currently, there is limited research on how to improve experiences with transitions in care following a hip fracture for older adults from the perspectives of those with lived experienced. The purpose of this study was to explore service recommendations made by patients, caregivers, healthcare providers, and decision-makers for improving transitions in care for older adults with hip fracture. Methods This descriptive qualitative study was part of a larger longitudinal qualitative multiple case study. Participants included older adults with hip fracture, caregivers supporting an individual with hip fracture, healthcare providers, and decision-makers. In-depth, semi-structured interviews were conducted with all participants, with patients and caregivers having the opportunity to participate in follow-up interviews as they transitioned out of hospital. All interviews were audio-recorded, transcribed verbatim, and analyzed thematically. Results A total of 47 participants took part in 65 interviews. We identified three main categories of recommendations: (1) hospital-based recommendations; (2) community-based recommendations; and (3) cross-sectoral based recommendations. Hospital-based recommendations focused on treating patients and families with respect, improving the consistency, frequency, and comprehensiveness of communication between hospital providers and between providers and families, and increasing staffing levels. Community-based recommendations included the early identification of at-risk individuals and providing preventative and educational programs. Cross-sectoral based recommendations were grounded in enhanced system navigation through communication and care navigators, particularly within primary and community care settings. Conclusions Our findings highlighted the central role primary care can play in providing targeted, integrated services for older adults with hip fracture. The recommendations outlined have the potential to improve experiences with care transitions for older adults with hip fracture, and thus, addressing and acting on them should be a priority.
Collapse
Affiliation(s)
- Lauren Cadel
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.,Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Kerry Kuluski
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Amanda C Everall
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada. .,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
45
|
Community Volunteers and Primary Care Providers Supporting Older Adults in System Navigation: A Mixed Methods Study. Int J Integr Care 2022; 22:18. [PMID: 35340348 PMCID: PMC8896251 DOI: 10.5334/ijic.5978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 02/19/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction: Primary care providers and community volunteers have important roles in supporting patient system navigation and utilization of community-based health and social services (CBHSS). This study aimed to explore the experiences and impacts of system navigation in a complex intervention supporting older adults. Methods: We used a convergent mixed methods design. Participants included primary care team members (n = 67), community volunteers (n = 38), and programme clients (n = 128) across six communities in Ontario, Canada. Data sources included focus groups, interviews, system navigation function survey for volunteers, CBHSS use survey for clients, and implementation data on CBHSS recommended by providers and volunteers and used by clients. Results: Results showed the different patterns of how CBHSS categories were recommended and ultimately used. Exercise-related CBHSS were both recommended and used, independence-related CBHSS were mostly only recommended with less uptake, and chronic health condition and diet/nutrition CBHSS were most often used by clients. Discussion: Primary care teams’ practice of system navigation was impacted by programme participation, including through learning about local CBHSS. However, volunteers felt more confident in tasks that did not include connecting to CBHSS. The programme did seem to result in many referrals, though the actual client uptake tended to be to more clinical rather than healthy lifestyle resources.
Collapse
|
46
|
Flynn MJ, Kronebusch BJ, Sikkink LA, Swanson KM, Niccum KJ, Crane SJ, Aoun B, Takahashi PY. Impact of the Registered Nurse Clinical Liaison Role in Ambulatory Care on Transitions of Care: A Retrospective Cohort Study. Prof Case Manag 2022; 27:58-66. [PMID: 35099419 DOI: 10.1097/ncm.0000000000000538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF STUDY To determine the relationship between engagement with the novel register nurse care liaison (RNCL) and enrollment in care management compared with usual care in hospitalized patients. PRIMARY PRACTICE SETTING Patients in the hospital from January 1, 2019, to September 30, 2019, who would be eligible for care management. METHODOLOGY AND SAMPLE This was a retrospective cohort study. The authors compared a group of 419 patients who utilized the services of the RNCL at any time during their hospital stay with the RNCL to a propensity matched control group of 833 patients, which consisted of patients who were hospitalized during the same time as the RNCL intervention group. Our primary outcome was enrollment in care management programs. Our secondary outcome was 30-day readmissions, emergency department (ED) use, and office visits. The authors compared baseline characteristics and outcomes across groups using Wilcoxon-Mann-Whitney and χ2 tests and performed an adjusted analysis using conditional logistic regression models controlling for patient education and previous health care utilization. RESULTS The authors matched 419 patients who had engaged an RNCL to 833 patients in the usual care group; this comprised the analytic cohort for this study. The authors found 67.1% of patients enrolled in a care management program with RNCL compared with only 15.3% in usual care (p < .0001). The authors found higher rates of enrollment in all programs of care management. After the full adjustment, the odds ratio for enrollment in any program was 13.7 (95% confidence interval: 9.3, 20.2) for RNCL compared with usual care. There was no difference between groups with 30-day hospitalization or ED visit. CONCLUSION In this matched study of 419 patients with RNCL engagement, the authors found significantly higher enrollment in all care management programs. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE These findings encourage further study of this care model. This could help enhance enrollment in care management programs, increase relationships between inpatient practice and ambulatory practice, as well as increase communication across the continuum of care.
Collapse
Affiliation(s)
- Mollie J Flynn
- Mollie J. Flynn, BSN, RN , is a bachelor's prepared registered nurse at Mayo Clinic in Rochester. She serves as the sole nurse clinical liaison for the Mayo Clinic Rochester/Kasson primary care clinic in Rochester, Minnesota
- Beckie J. Kronebusch, MS, APRN, CNS , is a master's prepared clinical nurse specialist. She currently works at Mayo Clinic Health System in La Crosse, Wisconsin
- Laura A. Sikkink, MSN, RN , is a master's prepared registered nurse. She is an ambulatory nurse manager, who manages the care coordination groups at the Mayo Clinic Rochester/Kasson primary care clinic in Rochester, Minnesota
- Kristi M. Swanson, MS , is a master's prepared principal health services analyst. She currently works for Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery at Mayo Clinic in Rochester, Minnesota
- Kelly J. Niccum, CCRP, PMP , is a project manager for the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery in Rochester, Minnesota
- Sarah J. Crane, MD , is a consultant in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic
- Bernard Aoun, MD , is a consultant in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic. He is an instructor of medicine and is board certified in Geriatrics
- Paul Y. Takahashi, MD , is a consultant and section head in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic
| | - Beckie J Kronebusch
- Mollie J. Flynn, BSN, RN , is a bachelor's prepared registered nurse at Mayo Clinic in Rochester. She serves as the sole nurse clinical liaison for the Mayo Clinic Rochester/Kasson primary care clinic in Rochester, Minnesota
- Beckie J. Kronebusch, MS, APRN, CNS , is a master's prepared clinical nurse specialist. She currently works at Mayo Clinic Health System in La Crosse, Wisconsin
- Laura A. Sikkink, MSN, RN , is a master's prepared registered nurse. She is an ambulatory nurse manager, who manages the care coordination groups at the Mayo Clinic Rochester/Kasson primary care clinic in Rochester, Minnesota
- Kristi M. Swanson, MS , is a master's prepared principal health services analyst. She currently works for Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery at Mayo Clinic in Rochester, Minnesota
- Kelly J. Niccum, CCRP, PMP , is a project manager for the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery in Rochester, Minnesota
- Sarah J. Crane, MD , is a consultant in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic
- Bernard Aoun, MD , is a consultant in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic. He is an instructor of medicine and is board certified in Geriatrics
- Paul Y. Takahashi, MD , is a consultant and section head in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic
| | - Laura A Sikkink
- Mollie J. Flynn, BSN, RN , is a bachelor's prepared registered nurse at Mayo Clinic in Rochester. She serves as the sole nurse clinical liaison for the Mayo Clinic Rochester/Kasson primary care clinic in Rochester, Minnesota
- Beckie J. Kronebusch, MS, APRN, CNS , is a master's prepared clinical nurse specialist. She currently works at Mayo Clinic Health System in La Crosse, Wisconsin
- Laura A. Sikkink, MSN, RN , is a master's prepared registered nurse. She is an ambulatory nurse manager, who manages the care coordination groups at the Mayo Clinic Rochester/Kasson primary care clinic in Rochester, Minnesota
- Kristi M. Swanson, MS , is a master's prepared principal health services analyst. She currently works for Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery at Mayo Clinic in Rochester, Minnesota
- Kelly J. Niccum, CCRP, PMP , is a project manager for the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery in Rochester, Minnesota
- Sarah J. Crane, MD , is a consultant in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic
- Bernard Aoun, MD , is a consultant in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic. He is an instructor of medicine and is board certified in Geriatrics
- Paul Y. Takahashi, MD , is a consultant and section head in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic
| | - Kristi M Swanson
- Mollie J. Flynn, BSN, RN , is a bachelor's prepared registered nurse at Mayo Clinic in Rochester. She serves as the sole nurse clinical liaison for the Mayo Clinic Rochester/Kasson primary care clinic in Rochester, Minnesota
- Beckie J. Kronebusch, MS, APRN, CNS , is a master's prepared clinical nurse specialist. She currently works at Mayo Clinic Health System in La Crosse, Wisconsin
- Laura A. Sikkink, MSN, RN , is a master's prepared registered nurse. She is an ambulatory nurse manager, who manages the care coordination groups at the Mayo Clinic Rochester/Kasson primary care clinic in Rochester, Minnesota
- Kristi M. Swanson, MS , is a master's prepared principal health services analyst. She currently works for Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery at Mayo Clinic in Rochester, Minnesota
- Kelly J. Niccum, CCRP, PMP , is a project manager for the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery in Rochester, Minnesota
- Sarah J. Crane, MD , is a consultant in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic
- Bernard Aoun, MD , is a consultant in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic. He is an instructor of medicine and is board certified in Geriatrics
- Paul Y. Takahashi, MD , is a consultant and section head in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic
| | - Kelly J Niccum
- Mollie J. Flynn, BSN, RN , is a bachelor's prepared registered nurse at Mayo Clinic in Rochester. She serves as the sole nurse clinical liaison for the Mayo Clinic Rochester/Kasson primary care clinic in Rochester, Minnesota
- Beckie J. Kronebusch, MS, APRN, CNS , is a master's prepared clinical nurse specialist. She currently works at Mayo Clinic Health System in La Crosse, Wisconsin
- Laura A. Sikkink, MSN, RN , is a master's prepared registered nurse. She is an ambulatory nurse manager, who manages the care coordination groups at the Mayo Clinic Rochester/Kasson primary care clinic in Rochester, Minnesota
- Kristi M. Swanson, MS , is a master's prepared principal health services analyst. She currently works for Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery at Mayo Clinic in Rochester, Minnesota
- Kelly J. Niccum, CCRP, PMP , is a project manager for the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery in Rochester, Minnesota
- Sarah J. Crane, MD , is a consultant in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic
- Bernard Aoun, MD , is a consultant in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic. He is an instructor of medicine and is board certified in Geriatrics
- Paul Y. Takahashi, MD , is a consultant and section head in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic
| | - Sarah J Crane
- Mollie J. Flynn, BSN, RN , is a bachelor's prepared registered nurse at Mayo Clinic in Rochester. She serves as the sole nurse clinical liaison for the Mayo Clinic Rochester/Kasson primary care clinic in Rochester, Minnesota
- Beckie J. Kronebusch, MS, APRN, CNS , is a master's prepared clinical nurse specialist. She currently works at Mayo Clinic Health System in La Crosse, Wisconsin
- Laura A. Sikkink, MSN, RN , is a master's prepared registered nurse. She is an ambulatory nurse manager, who manages the care coordination groups at the Mayo Clinic Rochester/Kasson primary care clinic in Rochester, Minnesota
- Kristi M. Swanson, MS , is a master's prepared principal health services analyst. She currently works for Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery at Mayo Clinic in Rochester, Minnesota
- Kelly J. Niccum, CCRP, PMP , is a project manager for the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery in Rochester, Minnesota
- Sarah J. Crane, MD , is a consultant in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic
- Bernard Aoun, MD , is a consultant in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic. He is an instructor of medicine and is board certified in Geriatrics
- Paul Y. Takahashi, MD , is a consultant and section head in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic
| | - Bernard Aoun
- Mollie J. Flynn, BSN, RN , is a bachelor's prepared registered nurse at Mayo Clinic in Rochester. She serves as the sole nurse clinical liaison for the Mayo Clinic Rochester/Kasson primary care clinic in Rochester, Minnesota
- Beckie J. Kronebusch, MS, APRN, CNS , is a master's prepared clinical nurse specialist. She currently works at Mayo Clinic Health System in La Crosse, Wisconsin
- Laura A. Sikkink, MSN, RN , is a master's prepared registered nurse. She is an ambulatory nurse manager, who manages the care coordination groups at the Mayo Clinic Rochester/Kasson primary care clinic in Rochester, Minnesota
- Kristi M. Swanson, MS , is a master's prepared principal health services analyst. She currently works for Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery at Mayo Clinic in Rochester, Minnesota
- Kelly J. Niccum, CCRP, PMP , is a project manager for the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery in Rochester, Minnesota
- Sarah J. Crane, MD , is a consultant in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic
- Bernard Aoun, MD , is a consultant in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic. He is an instructor of medicine and is board certified in Geriatrics
- Paul Y. Takahashi, MD , is a consultant and section head in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic
| | - Paul Y Takahashi
- Mollie J. Flynn, BSN, RN , is a bachelor's prepared registered nurse at Mayo Clinic in Rochester. She serves as the sole nurse clinical liaison for the Mayo Clinic Rochester/Kasson primary care clinic in Rochester, Minnesota
- Beckie J. Kronebusch, MS, APRN, CNS , is a master's prepared clinical nurse specialist. She currently works at Mayo Clinic Health System in La Crosse, Wisconsin
- Laura A. Sikkink, MSN, RN , is a master's prepared registered nurse. She is an ambulatory nurse manager, who manages the care coordination groups at the Mayo Clinic Rochester/Kasson primary care clinic in Rochester, Minnesota
- Kristi M. Swanson, MS , is a master's prepared principal health services analyst. She currently works for Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery at Mayo Clinic in Rochester, Minnesota
- Kelly J. Niccum, CCRP, PMP , is a project manager for the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery in Rochester, Minnesota
- Sarah J. Crane, MD , is a consultant in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic
- Bernard Aoun, MD , is a consultant in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic. He is an instructor of medicine and is board certified in Geriatrics
- Paul Y. Takahashi, MD , is a consultant and section head in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic
| |
Collapse
|
47
|
O'Neal MA, Zecavati N, Yu M, Spain R, Friedenberg SM, El Husseini N, Torres-Russotto DR, Feliciano B, Spears R, Baca C. Effects of Fragmentation and the Case for Greater Cohesion in Neurologic Care Delivery. Neurology 2022; 98:146-153. [PMID: 34795048 DOI: 10.1212/wnl.0000000000013079] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 11/04/2021] [Indexed: 11/15/2022] Open
Abstract
GOALS To define fragmentation in neurologic care delivery, explain the positive and negative drivers in neurologic practice that contribute to fragmentation, illustrate situations that increase fragmentation risk, emphasize the costs and impact on both patients and providers, and propose solutions that allow for more cohesive care. WORK GROUP The Transforming Leaders Program (TLP) class of 2020 was tasked by American Academy of Neurology (AAN) leadership to identify the leading trends in inpatient and outpatient neurology and to predict their effects on future neurologic practice. METHODS Research material included AAN databases, PubMed searches, discussion with topic experts, and AAN leadership. RESULTS Trends in care delivery are driven by changes in the work force, shifts in health care delivery, care costs, changes in evidence-based care, and patient factors. These trends can contribute to care fragmentation. Potential solutions to these problems are proposed based on care models developed in oncology and medicine. LIMITATIONS This article shares our opinions as there is a lack of evidence-based guidelines for optimal neurologic care delivery.
Collapse
Affiliation(s)
- Mary A O'Neal
- From the Brigham and Women's Hospital (M.A.O.N.), Boston, MA; Children's Hospital of Richmond (N.Z.), Richmond, VA; Baylor College of Medicine (M.Y.), Houston, TX; Oregon Health Sciences University (Rebecca Spain), Portland, OR; Geisinger Medical Center (S.M.F.), Danville, PA; Duke University Medical Center (N.E.H.), Durham, NC; University of Nebraska Medical Center (D.R.T.-R.), Omaha, NE; None (B.F.); University of Pennsylvania (Roderick Spears), Philadelphia, PA; and University of Colorado Medical Center (C.B.), Denver, CO.
| | - Nassim Zecavati
- From the Brigham and Women's Hospital (M.A.O.N.), Boston, MA; Children's Hospital of Richmond (N.Z.), Richmond, VA; Baylor College of Medicine (M.Y.), Houston, TX; Oregon Health Sciences University (Rebecca Spain), Portland, OR; Geisinger Medical Center (S.M.F.), Danville, PA; Duke University Medical Center (N.E.H.), Durham, NC; University of Nebraska Medical Center (D.R.T.-R.), Omaha, NE; None (B.F.); University of Pennsylvania (Roderick Spears), Philadelphia, PA; and University of Colorado Medical Center (C.B.), Denver, CO
| | - Melissa Yu
- From the Brigham and Women's Hospital (M.A.O.N.), Boston, MA; Children's Hospital of Richmond (N.Z.), Richmond, VA; Baylor College of Medicine (M.Y.), Houston, TX; Oregon Health Sciences University (Rebecca Spain), Portland, OR; Geisinger Medical Center (S.M.F.), Danville, PA; Duke University Medical Center (N.E.H.), Durham, NC; University of Nebraska Medical Center (D.R.T.-R.), Omaha, NE; None (B.F.); University of Pennsylvania (Roderick Spears), Philadelphia, PA; and University of Colorado Medical Center (C.B.), Denver, CO
| | - Rebecca Spain
- From the Brigham and Women's Hospital (M.A.O.N.), Boston, MA; Children's Hospital of Richmond (N.Z.), Richmond, VA; Baylor College of Medicine (M.Y.), Houston, TX; Oregon Health Sciences University (Rebecca Spain), Portland, OR; Geisinger Medical Center (S.M.F.), Danville, PA; Duke University Medical Center (N.E.H.), Durham, NC; University of Nebraska Medical Center (D.R.T.-R.), Omaha, NE; None (B.F.); University of Pennsylvania (Roderick Spears), Philadelphia, PA; and University of Colorado Medical Center (C.B.), Denver, CO
| | - Scott M Friedenberg
- From the Brigham and Women's Hospital (M.A.O.N.), Boston, MA; Children's Hospital of Richmond (N.Z.), Richmond, VA; Baylor College of Medicine (M.Y.), Houston, TX; Oregon Health Sciences University (Rebecca Spain), Portland, OR; Geisinger Medical Center (S.M.F.), Danville, PA; Duke University Medical Center (N.E.H.), Durham, NC; University of Nebraska Medical Center (D.R.T.-R.), Omaha, NE; None (B.F.); University of Pennsylvania (Roderick Spears), Philadelphia, PA; and University of Colorado Medical Center (C.B.), Denver, CO
| | - Nada El Husseini
- From the Brigham and Women's Hospital (M.A.O.N.), Boston, MA; Children's Hospital of Richmond (N.Z.), Richmond, VA; Baylor College of Medicine (M.Y.), Houston, TX; Oregon Health Sciences University (Rebecca Spain), Portland, OR; Geisinger Medical Center (S.M.F.), Danville, PA; Duke University Medical Center (N.E.H.), Durham, NC; University of Nebraska Medical Center (D.R.T.-R.), Omaha, NE; None (B.F.); University of Pennsylvania (Roderick Spears), Philadelphia, PA; and University of Colorado Medical Center (C.B.), Denver, CO
| | - Diego R Torres-Russotto
- From the Brigham and Women's Hospital (M.A.O.N.), Boston, MA; Children's Hospital of Richmond (N.Z.), Richmond, VA; Baylor College of Medicine (M.Y.), Houston, TX; Oregon Health Sciences University (Rebecca Spain), Portland, OR; Geisinger Medical Center (S.M.F.), Danville, PA; Duke University Medical Center (N.E.H.), Durham, NC; University of Nebraska Medical Center (D.R.T.-R.), Omaha, NE; None (B.F.); University of Pennsylvania (Roderick Spears), Philadelphia, PA; and University of Colorado Medical Center (C.B.), Denver, CO
| | - Briseida Feliciano
- From the Brigham and Women's Hospital (M.A.O.N.), Boston, MA; Children's Hospital of Richmond (N.Z.), Richmond, VA; Baylor College of Medicine (M.Y.), Houston, TX; Oregon Health Sciences University (Rebecca Spain), Portland, OR; Geisinger Medical Center (S.M.F.), Danville, PA; Duke University Medical Center (N.E.H.), Durham, NC; University of Nebraska Medical Center (D.R.T.-R.), Omaha, NE; None (B.F.); University of Pennsylvania (Roderick Spears), Philadelphia, PA; and University of Colorado Medical Center (C.B.), Denver, CO
| | - Roderick Spears
- From the Brigham and Women's Hospital (M.A.O.N.), Boston, MA; Children's Hospital of Richmond (N.Z.), Richmond, VA; Baylor College of Medicine (M.Y.), Houston, TX; Oregon Health Sciences University (Rebecca Spain), Portland, OR; Geisinger Medical Center (S.M.F.), Danville, PA; Duke University Medical Center (N.E.H.), Durham, NC; University of Nebraska Medical Center (D.R.T.-R.), Omaha, NE; None (B.F.); University of Pennsylvania (Roderick Spears), Philadelphia, PA; and University of Colorado Medical Center (C.B.), Denver, CO
| | - Christine Baca
- From the Brigham and Women's Hospital (M.A.O.N.), Boston, MA; Children's Hospital of Richmond (N.Z.), Richmond, VA; Baylor College of Medicine (M.Y.), Houston, TX; Oregon Health Sciences University (Rebecca Spain), Portland, OR; Geisinger Medical Center (S.M.F.), Danville, PA; Duke University Medical Center (N.E.H.), Durham, NC; University of Nebraska Medical Center (D.R.T.-R.), Omaha, NE; None (B.F.); University of Pennsylvania (Roderick Spears), Philadelphia, PA; and University of Colorado Medical Center (C.B.), Denver, CO
| |
Collapse
|
48
|
Kokorelias KM, DasGupta T, Hitzig SL. Designing the Ideal Patient Navigation Program for Older Adults with Complex Needs: A Qualitative Exploration of the Preferences of Key Informants. J Appl Gerontol 2021; 41:1002-1010. [PMID: 34905440 DOI: 10.1177/07334648211059056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Navigating the healthcare system is complex. Many older adults and their family members report sub-optimal outcomes when transitioning from hospital to home. Patient navigation has been introduced as a model of care to help improve hospital to home transitions and to better integrate care across care environments. There are no best-practice guidelines for designing a patient navigation program for older adults with complex needs. This qualitative descriptive study interviewed 38 healthcare professionals to determine key characteristics of the "ideal" patient navigator program. Thematic analysis revealed four themes describing key components of an ideal patient navigator program for older adults with complex needs: (1) Easy accessibility and open communication amongst staff; (2) flexible eligibility requirements; (3) characteristics of the patient navigator; and (4) appropriate program size and duration. We suggest directions for future research, program design, and implementation considers to improve patient navigation for older adults and their family caregivers.
Collapse
Affiliation(s)
- Kristina M Kokorelias
- St John's Rehab Research Program, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | | | - Sander L Hitzig
- St John's Rehab Research Program, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Temerty Faculty of Medicine, Rehabilitation Sciences Institute, 12366University of Toronto, Toronto, Ontario, Canada.,Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, 12366University of Toronto, Toronto, Canada
| |
Collapse
|
49
|
Hannan-Jones CM, Mitchell GK, Mutch AJ. The nurse navigator: Broker, boundary spanner and problem solver. Collegian 2021. [DOI: 10.1016/j.colegn.2021.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
50
|
Kokorelias KM, Posa S, DasGupta T, Ziegler N, Hitzig SL. “I think like if Albert Einstein and Superman had a baby, that's what it would take”: The experiences and perceptions of community and hospital healthcare professionals in a seniors’ patient navigator program. INTERNATIONAL JOURNAL OF CARE COORDINATION 2021. [DOI: 10.1177/20534345211063482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction The success of new patient navigation programs have mostly been described from the perspectives of patient outcomes. Little is known about how patient navigators interact with healthcare professionals in the community and in hospital settings. Methods A qualitative study using a phenomenological analysis was undertaken to depict the lived experiences of Ontario (Canada) healthcare providers who have interacted with a patient navigator. Semi-structured interviews were conducted with 42 healthcare professionals, including frontline care providers ( n = 25) and administrators ( n = 16) from hospital ( n = 21) and community care settings ( n = 21). Results Participants’ experiences were reflected in one overarching theme: role clarity and three emergent themes related to the overarching theme: (i) concerns over accountability of patient care (ii) trust (iii) attainable-but-not. Participants described an inconsistent understanding of the role of patient navigators which led to uncertainty regarding their role in patient care. The current nature of the healthcare system influenced participants’ belief in the sustainability of patient navigation model of care. Despite these experiences, participants felt that patient navigators could help healthcare providers care for patients by preventing potential crises from developing and enhancing their knowledge about services. Discussion This study expands our understanding of patient navigation programs by exploring the experiences and perceptions of healthcare professionals, thereby providing new perspectives into components that support the successful health outcomes of older adults being supported by a patient navigator. The implications of findings for research, clinical practice, and policy are described.
Collapse
Affiliation(s)
- Kristina M Kokorelias
- St John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Stephanie Posa
- St John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
| | | | | | - Sander L Hitzig
- St John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| |
Collapse
|