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Hernandez M, Guarino H, Kozlowski S, Srivastava A, Schenkel R, Tapia T, Seabrook TB, Nash D, Irvine MK. Addressing Mental Health Barriers in HIV Care Coordination Is Crucial to Providing Optimal HIV/AIDS Care. AIDS Patient Care STDS 2024; 38:107-114. [PMID: 38471091 DOI: 10.1089/apc.2023.0240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
For people with HIV (PWH) who have psychological comorbidities, effective management of mental health issues is crucial to achieving and maintaining viral suppression. Care coordination programs (CCPs) have been shown to improve outcomes across the HIV care continuum, but little research has focused on the role of care coordination in supporting the mental health of PWH. This study reports qualitative findings from the Program Refinements to Optimize Model Impact and Scalability based on Evidence (PROMISE) study, which evaluated a revised version of an HIV CCP for Ryan White Part A clients in New York City. Semistructured interviews were conducted with 30 providers and 27 clients from 6 CCP-implementing agencies to elucidate barriers and facilitators of program engagement. Transcripts were analyzed for key themes related to clients' mental health needs and providers' successes and challenges in meeting these needs. Providers and clients agreed that insufficiently managed mental health issues are a common barrier to achieving and maintaining viral suppression. Although the CCP model calls for providers to address clients' unmet mental health needs primarily through screening and referrals to psychiatric and/or psychological care, both clients and providers reported that the routine provision of emotional support is a major part of providers' role that is highly valued by clients. Some concerns raised by providers included insufficient training to address clients' mental health needs and an inability to document the provision of emotional support as a delivered service. These findings suggest the potential value of formally integrating mental health services into HIV care coordination provision. ClinicalTrials.gov protocol number: NCT03628287.
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Affiliation(s)
- Miguel Hernandez
- Institute for Implementation Science in Population Health (ISPH), CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Honoria Guarino
- Institute for Implementation Science in Population Health (ISPH), CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Sarah Kozlowski
- Institute for Implementation Science in Population Health (ISPH), CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Avantika Srivastava
- Institute for Implementation Science in Population Health (ISPH), CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Rachel Schenkel
- Institute for Implementation Science in Population Health (ISPH), CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Thamara Tapia
- Institute for Implementation Science in Population Health (ISPH), CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Tyeirra B Seabrook
- Institute for Implementation Science in Population Health (ISPH), CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Denis Nash
- Institute for Implementation Science in Population Health (ISPH), CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Mary K Irvine
- Institute for Implementation Science in Population Health (ISPH), CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
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Kallmyer BA, Bass D, Baumgart M, Callahan CM, Dulaney S, Evertson LC, Fazio S, Judge KS, Samus Q. Dementia care navigation: Building toward a common definition, key principles, and outcomes. Alzheimers Dement (N Y) 2023; 9:e12408. [PMID: 37533688 PMCID: PMC10392594 DOI: 10.1002/trc2.12408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/23/2023] [Accepted: 04/17/2023] [Indexed: 08/04/2023]
Abstract
INTRODUCTION As the complexity of medical treatments and patient care systems have increased, the concept of patient navigation is growing in both popularity and breadth of application. Patient navigators are trained personnel whose role is not to provide clinical care, but to partner with patients to help them identify their needs and goals and then overcome modifiable patient-, provider-, and systems-level barriers. Due to its high incidence, duration, and medical-social complexity, dementia is an ideal candidate for a patient-centric health care delivery model such as care navigation. METHODS The Alzheimer's Association formed an expert workgroup of researchers in the field of dementia care navigation to identify evidence-based guidelines. RESULTS Recognizing the unique and challenging needs of persons living with dementia and their care partners, several U.S. dementia care navigation programs have been developed and assessed in recent years. Collectively these programs demonstrate that persons living with dementia and their care partners benefit from dementia care navigation. Improved care system outcomes for the person living with dementia include reduced emergency department visits, lower hospital readmissions, fewer days hospitalized, and shorter delays in long-term care placement. Well-being is also increased, as there is decreased depression, illness, strain, embarrassment, and behavioral symptoms and increased self-reported quality of life. For care partners, dementia navigation resulted in decreased depression, burden, and unmet needs. DISCUSSION This article presents principles of dementia care navigation to inform existing and emerging dementia care navigation programs. Highlights Several U.S. dementia care navigation programs have demonstrated outcomes for persons living with dementia, care partners, and health systems.The Alzheimer's Association formed an expert workgroup of researchers in the field of dementia care navigation to create a shared definition and identify evidence-based guidelines or principles.These outlined principles of dementia care navigation can inform existing and emerging dementia care navigation programs.
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Affiliation(s)
| | - David Bass
- Benjamin Rose Institute on AgingClevelandOhioUSA
| | | | | | - Sarah Dulaney
- UCSF Memory and Aging CenterSan FranciscoCaliforniaUSA
| | | | - Sam Fazio
- Alzheimer's AssociationChicagoIllinoisUSA
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Tsapatsaris A, Bhima M, Sekhar TC. Regarding "Burden of Comorbidities and Healthcare Resource Utilization Among Medicaid-Enrolled Extremely Premature Infants". J Health Econ Outcomes Res 2023; 10:77-79. [PMID: 37033150 PMCID: PMC10076213 DOI: 10.36469/001c.73989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 06/19/2023]
Abstract
In their article, Mowitz et al investigated the burden of comorbidities and healthcare resource utilization among extremely premature infants enrolled in Medicaid, laying a foundation for further policy action.
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Affiliation(s)
- Ava Tsapatsaris
- Gallatin School of Individualized Study New York University, New York, NY
| | - Miran Bhima
- Trinity College of Arts and Sciences Duke University, Durham, North Carolina
| | - Tejas C Sekhar
- Division of Pulmonary and Critical Care Medicine Washington University School of Medicine, St. Louis, Missouri
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4
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Vu M, Besera G, Ta D, Escoffery C, Kandula NR, Srivanjarean Y, Burks AJ, Dimacali D, Rizal P, Alay P, Htun C, Hall KS. System-level factors influencing refugee women's access and utilization of sexual and reproductive health services: A qualitative study of providers' perspectives. Front Glob Womens Health 2022; 3:1048700. [PMID: 36589147 PMCID: PMC9794861 DOI: 10.3389/fgwh.2022.1048700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/18/2022] [Indexed: 12/15/2022] Open
Abstract
Refugee women have poor outcomes and low utilization of sexual and reproductive health (SRH) services, which may be driven by access to and quality of SRH services at their resettled destinations. While healthcare providers offer valuable insights into these topics, little research has explored United States (U.S.) providers' experiences. To fill this literature gap, we investigate U.S. providers' perspectives of healthcare system-related factors influencing refugee women's access and utilization of SRH services. Between July and December 2019, we conducted in-depth, semi-structured interviews with 17 providers serving refugee women in metropolitan Atlanta in the state of Georgia (United States). We used convenience and snowball sampling for recruitment. We inquired about system-related resources, facilitators, and barriers influencing SRH services access and utilization. Two coders analyzed the data using a qualitative thematic approach. We found that transportation availability was crucial to refugee women's SRH services access. Providers noted a tension between refugee women's preferred usage of informal interpretation assistance (e.g., family and friends) and healthcare providers' desire for more formal interpretation services. Providers reported a lack of funding and human resources to offer comprehensive SRH services as well as several challenges with using a referral system for women to get SRH care in other systems. Culturally and linguistically-concordant patient navigators were successful at helping refugee women navigate the healthcare system and addressing language barriers. We discussed implications for future research and practice to improve refugee women's SRH care access and utilization. In particular, our findings underscore multilevel constraints of clinics providing SRH care to refugee women and highlight the importance of transportation services and acceptable interpretation services. While understudied, the use of patient navigators holds potential for increasing refugee women's SRH care access and utilization. Patient navigation can both effectively address language-related challenges for refugee women and help them navigate the healthcare system for SRH. Future research should explore organizational and external factors that can facilitate or hinder the implementation of patient navigators for refugee women's SRH care.
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Affiliation(s)
- Milkie Vu
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States,Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States,Correspondence: Milkie Vu
| | - Ghenet Besera
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Danny Ta
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States
| | - Cam Escoffery
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Namratha R. Kandula
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States,Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | | | - Amanda J. Burks
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States,Emory University Physician Assistant Program, School of Medicine, Emory University, Atlanta, GA, United States
| | - Danielle Dimacali
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States
| | - Pabitra Rizal
- Center for Pan Asian Community Services, Atlanta, GA, United States
| | - Puspa Alay
- Center for Pan Asian Community Services, Atlanta, GA, United States
| | - Cho Htun
- Center for Pan Asian Community Services, Atlanta, GA, United States
| | - Kelli S. Hall
- Heilbrunn Department of Population & Family Health, Mailman School of Public Health, Columbia University, New York, NY, United States
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McQueen A, Kreuter MW, Herrick CJ, Li L, Brown DS, Haire-Joshu D. Associations among social needs, health and healthcare utilization, and desire for navigation services among US Medicaid beneficiaries with type 2 diabetes. Health Soc Care Community 2022; 30:1035-1044. [PMID: 33704849 PMCID: PMC8433262 DOI: 10.1111/hsc.13296] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 10/14/2020] [Accepted: 01/07/2021] [Indexed: 05/03/2023]
Abstract
The purpose of this study was to better understand the number and types of social needs experienced by Medicaid beneficiaries with type 2 diabetes, and how their social needs are associated with key health indicators. Also examined were factors that influence patients' interest in navigation services for health and social needs to inform future interventions and service delivery. The study expands upon prior research, much of which has focused on only one social need (e.g., food insecurity) or one health outcome. The hypothesis was that among individuals with type 2 diabetes, those with a greater number of social needs would report more health-related problems and be more interested in receiving social needs navigation services. Participants completed a cross-sectional survey by phone (n = 95) or online (n = 14). Most (85%) reported having at least one social need (M = 2.5, SD = 2.2), most commonly not having enough money for unexpected expenses (68%) or necessities like food, shelter and clothing (31%), medical costs (24%), and utilities (23%). Results supported our comprehensive conceptual model. Having more social needs was associated with greater perceived stress, diabetes distress, problems with sleep and executive and cognitive functioning, less frequent diabetes self-care activities, more days of poor mental health and activity limitations, worse self-reported health and more hospitalisations. Number of social needs also was positively associated with interest in having a social needs navigator. Social needs were not associated with days of poor physical health, BMI, self-reported A1C or smoking status. Social needs were associated with a wide range of indicators of poor health and well-being. Participants with the greatest social need burden were most open to intervention.
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Affiliation(s)
- Amy McQueen
- Department of Internal Medicine, School of Medicine, Washington University in St. Louis, MO
- Brown School of Social Work, Washington University in St. Louis, MO
| | | | - Cynthia J. Herrick
- Department of Internal Medicine, School of Medicine, Washington University in St. Louis, MO
- Department of Surgery, Division of Public Health Sciences, School of Medicine, Washington University in St. Louis, MO
| | - Linda Li
- Brown School of Social Work, Washington University in St. Louis, MO
| | - Derek S. Brown
- Brown School of Social Work, Washington University in St. Louis, MO
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Gilworth G, Lewin S, Wright AJ, Taylor SJ, Tuffnell R, Hogg L, Hopkinson NS, Singh SJ, White P. The lay health worker-patient relationship in promoting pulmonary rehabilitation (PR) in COPD: What makes it work? Chron Respir Dis 2020; 16:1479973119869329. [PMID: 31450952 PMCID: PMC6710699 DOI: 10.1177/1479973119869329] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Lay health workers (LHWs) can improve access to services and adherence to treatment, as well as promoting self-care and prevention. Their effect in promoting uptake and adherence in pulmonary rehabilitation (PR) for chronic obstructive pulmonary disease (COPD) has not been tested. PR is the most effective treatment for the symptoms and disability of COPD, but this effectiveness is undermined by poor rates of completion. Trained LHWs with COPD, who also have first-hand experience of PR, are well placed to help overcome the documented barriers to its completion. The relationship between LHWs and patients may be one of the keys to their effectiveness but it has been little explored. Semi-structured qualitative interviews were used with the aim of examining the LHW-patient partnership in a feasibility study of trained PR-experienced LHWs used to support COPD patients referred to PR. Twelve volunteers with COPD who completed LHW training supported 66 patients referred for PR. All 12 of these LHWs gave end-of-study interviews, 21 COPD patients supported by LHWs were also interviewed. Patients reported that the LHWs were keen to share their experiences of PR, and that this had a positive impact. The enthusiasm of the LHWs for PR was striking. The common bond between LHWs and patients of having COPD together with the LHWs positive, first-hand experience of PR were dominant and recurring themes in their relationship.
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Affiliation(s)
- Gill Gilworth
- 1 Department of Public Health and Primary Care, School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Simon Lewin
- 2 Norwegian Institute of Public Health, Oslo, Norway.,3 Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Alison J Wright
- 4 Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Stephanie Jc Taylor
- 5 Bart's and London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Rachel Tuffnell
- 6 The Pulmonary Rehabilitation and Integrated Respiratory Team, King's College Hospital NHS Foundation Trust, London, UK
| | - Lauren Hogg
- 7 Physiotherapy Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Sally J Singh
- 9 Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Patrick White
- 1 Department of Public Health and Primary Care, School of Population Health and Environmental Sciences, King's College London, London, UK
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Kim JK, Garrett L, Latimer R, Nishizaki LK, Kimura JA, Taira D, Sentell T. Ke Ku'una Na'au: A Native Hawaiian Behavioral Health Initiative at The Queen's Medical Center. Hawaii J Med Public Health 2019; 78:83-89. [PMID: 31285976 PMCID: PMC6603896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Although acute care facilities have not typically focused on resolving the psychosocial determinants of health, new models are emerging. This article provides details of the Ke Ku'una Na'au (KKN) Native Hawaiian Behavioral Health Initiative implemented in 2016 at The Queen's Medical Center in Honolulu, Hawai'i. The program is focused on reducing hospital readmissions for socially and economically vulnerable Native Hawaiian adults and improving their health care outcomes after hospitalization. The program was piloted on 2 medical units to assist patients who identified as Native Hawaiian, were ages 18 and older, and living with chronic diseases, psychosocial needs, and/or behavioral health problems. The program model was developed using a team of Native Hawaiian community health workers referred to as navigators, who were supported by an advanced practice nurse and a project coordinator/social worker. Navigators met patients during their inpatient stay and then followed patients post discharge to support them across any array of interpersonal needs for at least 30 days post-discharge. Goals were to assist patients with attending a post-hospital follow-up appointment, facilitate implementation of the discharge plan, and address social determinants of health that were impacting access to care. In 2017, 338 patients received care from the KKN program, a number that has grown since that time. In 2015, the baseline readmission rate for Native Hawaiians on the 2 medical units was 16.6% (for 440 Native Hawaiian patients in total). In 2017, the readmission rate for Native Hawaiians patients on the two medical units was 12.6% (for 445 Native Hawaiian patients, inclusive of KKN patients) (P=.092). This decrease suggests that the KKN program has been successful at reducing readmissions for vulnerable patients and, thus, improving care for Native Hawaiians in the health system generally. The KKN program has offered relevant, culturally sensitive care meeting a complex, personalized array of needs for over 338 patients and has shown demonstrated success in its outcomes. This information will be useful to other acute care organizations considering similar programs.
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Affiliation(s)
| | - Lisa Garrett
- The Queen's Medical Center, Honolulu, HI (LG, RL)
| | | | | | - Jo Ann Kimura
- The Queen's Health Systems, Honolulu, HI (JK, LKN, JAK)
| | - Deborah Taira
- Daniel K. Inouye College of Pharmacy, University of Hawai‘i at Hilo, Hilo, HI (DT)
| | - Tetine Sentell
- Office of Public Health Studies, University of Hawai‘i at Mānoa, Honolulu, HI (TS)
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Nishizaki LK, Negrillo AH, Ho'opai JM, Naniole R, Hanake'awe D, Pu'ou K. "It starts with 'Aloha…'" Stories by the Patient Navigators of Ke Ku'una Na'au Program at The Queen's Medical Center. Hawaii J Med Public Health 2019; 78:90-97. [PMID: 31285977 PMCID: PMC6603887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The Ke Ku'una Na'au (KKN) navigators were first hired in 2016 at The Queen's Medical Center (QMC) in Honolulu, Hawai'i, with a focus on reducing hospital readmissions for socially and economically vulnerable Native Hawaiian adults. To our knowledge, QMC was the first acute care hospital in the state to implement the use of community health workers into the health care system as navigators for patient needs in the community following discharge. This article tells the story of our experiences as the 5 patient navigators from the Native Hawaiian community during the first 2 years of the program. The article describes how we ended up in this vocation and a summary of what we have learned. We also describe walking with our patients through their journey of healing, a journey which begins at the bedside during hospitalization starting with the moment we say, "Aloha." (A companion article in this issue describes the KKN program history, design, and clinical outcomes in more detail.) We hope these stories are inspirational to others who fill the community health worker role and may walk in our shoes in other health care organizations and/or help support the planning and implementation of similar programs to meet other communities' health needs. We consider the implications for community-clinical linkages.
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Affiliation(s)
| | | | | | - Robert Naniole
- The Queen's Medical Center, Honolulu, HI (AHN, JMH, RN, DH, KP)
| | | | - Kehau Pu'ou
- The Queen's Medical Center, Honolulu, HI (AHN, JMH, RN, DH, KP)
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9
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Cervantes L, Chonchol M, Hasnain-Wynia R, Steiner JF, Havranek E, Hull M, Rice J, Kendrick J, Alamillo X, Camacho C, Fischer S. Peer Navigator Intervention for Latinos on Hemodialysis: A Single-Arm Clinical Trial. J Palliat Med 2019; 22:838-843. [PMID: 30702365 DOI: 10.1089/jpm.2018.0439] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Latinos with end-stage renal disease (ESRD) have worse mental and kidney composite health-related quality of life (HRQOL) scores compared to non-Latino ESRD patients. Latino ESRD patients uniquely report that social factors (e.g., lack of care coordination, food insecurity, and low health literacy) and mental health influence their HRQOL. We developed a culturally tailored peer navigator (PN) intervention to improve the HRQOL of Latinos on hemodialysis. Objective: To determine the feasibility of the PN intervention. Design: Single-arm prospective study. The PN provided individualized support with advance care planning, care coordination, and counseling about the importance of diet and mental health. Setting and Participants: Latino with ESRD receiving scheduled outpatient thrice-weekly hemodialysis or reliant on emergency-only hemodialysis in Denver. Main measures: Recruitment, retention rates, data completeness, intervention dose, patient- and staff-reported satisfaction with the intervention. Results: Of 49 eligible patients, 40 (82%) agreed to participate. The majority of participants received scheduled outpatient hemodialysis (75%), 20 were women (50%), with a mean (standard deviation [SD]) age of 56 (13) years. No participants withdrew from the intervention. One participant died. The mean (SD) number of PN visits per participant was 7 (2) and the mean (SD) length of the visits was 97 minutes (49). The majority of visits took place at the hemodialysis facility (59%) and home (27%). The vast majority of participants reported that the PN improved their quality of life as a patient on hemodialysis (95%). Conclusions: The PN intervention achieved feasibility goals and was well received by participants.
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Affiliation(s)
- Lilia Cervantes
- 1 Department of Medicine, Denver Health, Denver, Colorado.,2 Department of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Michel Chonchol
- 2 Department of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | | | - John F Steiner
- 4 Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | | | - Madelyne Hull
- 1 Department of Medicine, Denver Health, Denver, Colorado
| | - John Rice
- 5 Colorado School of Public Health, University of Colorado, Denver, Colorado
| | - Jessica Kendrick
- 2 Department of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | | | | | - Stacy Fischer
- 7 Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado
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Nair N, Kvizhinadze G, Blakely T. Cancer Care Coordinators to Improve Tamoxifen Persistence in Breast Cancer: How Heterogeneity in Baseline Prognosis Impacts on Cost-Effectiveness. Value Health 2016; 19:936-944. [PMID: 27987643 DOI: 10.1016/j.jval.2016.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 05/05/2016] [Accepted: 05/28/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To assess the cost-effectiveness of a cancer care coordinator (CCC) in helping women with estrogen receptor positive (ER+) early breast cancer persist with tamoxifen for 5 years. METHODS We investigated the cost-effectiveness of a CCC across eight breast cancer subtypes, defined by progesterone receptor (PR) status, human epidermal growth factor receptor 2 (HER2) status, and local/regional spread. These subtypes range from excellent to poorer prognoses. The CCC helped in improving tamoxifen persistence by providing information, checking-in by phone, and "troubleshooting" concerns. We constructed a Markov macrosimulation model to estimate health gain (in quality-adjusted life-years or QALYs) and health system costs in New Zealand, compared with no CCC. Participants were modeled until death or till the age of 110 years. Some input parameters (e.g., the impact of a CCC on tamoxifen persistence) had sparse evidence. Therefore, we used estimates with generous uncertainty and conducted sensitivity analyses. RESULTS The cost-effectiveness of a CCC for regional ER+/PR-/HER2+ breast cancer (worst prognosis) was NZ $23,400 (US $15,800) per QALY gained, compared with NZ $368,500 (US $248,800) for local ER+/PR+/HER2- breast cancer (best prognosis). Using a cost-effectiveness threshold of NZ $45,000 (US $30,400) per QALY, a CCC would be cost-effective only in the four subtypes with the worst prognoses. CONCLUSIONS There is value in investigating cost-effectiveness by different subtypes within a disease. In this example of breast cancer, the poorer the prognosis, the greater the health gains from a CCC and the better the cost-effectiveness. Incorporating heterogeneity in a cost-utility analysis is important and can inform resource allocation decisions. It is also feasible to undertake in practice.
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Affiliation(s)
- Nisha Nair
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme, Department of Public Health, University of Otago Wellington, Wellington, New Zealand.
| | - Giorgi Kvizhinadze
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme, Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Tony Blakely
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme, Department of Public Health, University of Otago Wellington, Wellington, New Zealand
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Jean-Pierre P, Cheng Y, Wells KJ, Freund KM, Snyder FR, Fiscella K, Holden AE, Paskett E, Dudley D, Simon MA, Valverde P. Satisfaction with cancer care among underserved racial-ethnic minorities and lower-income patients receiving patient navigation. Cancer 2016; 122:1060-7. [PMID: 26849163 PMCID: PMC4803516 DOI: 10.1002/cncr.29902] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 12/23/2015] [Accepted: 12/28/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patient navigation is a barrier-focused program of care coordination designed to achieve timely and high-quality cancer-related care for medically underserved racial-ethnic minorities and the poor. However, to the authors' knowledge, few studies to date have examined the relationship between satisfaction with navigators and cancer-related care. METHODS The authors included data from 1345 patients with abnormal cancer screening tests or a definitive cancer diagnosis who participated in the Patient Navigation Research Program to test the efficacy of patient navigation. Participants completed demographic questionnaires and measures of patient satisfaction with cancer-related care (PSCC) and patient satisfaction with interpersonal relationship with navigator (PSN-I). The authors obtained descriptive statistics to characterize the sample and conducted regression analyses to assess the degree of association between PSN-I and PSCC, controlling for demographic and clinical factors. Analyses of variance were conducted to examine group differences controlling for statistically significant covariates. RESULTS Statistically significant relationships were found between the PSCC and PSN-I for patients with abnormal cancer screening tests (1040 patients; correlation coefficient (r), 0.4 [P<.001]) and those with a definitive cancer diagnosis (305 patients; correlation coefficient, 0.4 [P<.001]). The regression analysis indicated that having an abnormal colorectal cancer screening test in the abnormal screening test group and increased age and minority race-ethnicity status in the cancer diagnosis group were associated with a higher satisfaction with cancer care (P<.01). CONCLUSIONS Satisfaction with navigators appears to be significantly associated with satisfaction with cancer-related care. Information regarding the patient-navigator relationship should be integrated into patient navigation programs to maximize the likelihood of reducing caner disparities and mortality for medically underserved racial-ethnic minorities and the poor.
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Affiliation(s)
- Pascal Jean-Pierre
- University of Notre Dame, Notre Dame, IN
- Cancer Neurocognitive Translational Research Lab, Notre Dame, IN
| | - Ying Cheng
- University of Notre Dame, Notre Dame, IN
| | | | | | | | - Kevin Fiscella
- University of Rochester Medical Center, Department of Family Medicine and Public Health Sciences, Rochester, NY
| | - Alan E. Holden
- University of Texas Health Science Center, Institute for Health Promotion Research, San Antonio, TX
| | | | - Donald Dudley
- University of Virginia School of Medicine, Charlottesville, VA
| | | | - Patricia Valverde
- University of Colorado Denver, Colorado School of Public Health, Denver, Colorado
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Genoff MC, Zaballa A, Gany F, Gonzalez J, Ramirez J, Jewell ST, Diamond LC. Navigating Language Barriers: A Systematic Review of Patient Navigators' Impact on Cancer Screening for Limited English Proficient Patients. J Gen Intern Med 2016; 31:426-34. [PMID: 26786875 PMCID: PMC4803699 DOI: 10.1007/s11606-015-3572-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 06/18/2015] [Accepted: 12/14/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To systematically review the literature on the impact of patient navigators on cancer screening for limited English proficient (LEP) patients. DATA SOURCES Electronic databases (PubMed, PsycINFO via OVID, Web of Science, Cochrane, EMBASE, and Scopus) through 8 May 2015. ELIGIBILITY CRITERIA Articles in this review had: (1) a study population of LEP patients eligible for breast, cervical or colorectal cancer screenings, (2) a patient navigator intervention to provide services prior to or during cancer screening, (3) a comparison of the patient navigator intervention to either a control group or another intervention, and (4) language-specific outcomes related to the patient navigator intervention. STUDY APPRAISAL We assessed the quality of the articles using the Downs and Black Scale. RESULTS Fifteen studies met the inclusion criteria and evaluated the screening rates for breast, colorectal, and cervical cancer in 15 language populations. Fourteen studies resulted in improved screening rates for LEP patients between 7 and 60%. There was great variability in the patient navigation interventions evaluated. Training received by navigators was not reported in nine of the studies and no studies assessed the language skills of the patient navigators in English or the target language. LIMITATIONS This study is limited by the variability in study designs and limited reporting on patient navigator interventions, which reduces the ability to draw conclusions on the full effect of patient navigators. CONCLUSIONS Overall, we found evidence that navigators improved screening rates for breast, cervical and colorectal cancer screening for LEP patients. Future studies should systematically collect data on the training curricula for navigators and assess their English and non-English language skills in order to identify ways to reduce disparities for LEP patients.
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Affiliation(s)
- Margaux C Genoff
- Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Memorial Sloan-Kettering Cancer Center, New York City, NY, USA
- Department of Psychology, New School for Social Research, New York, NY, USA
| | | | - Francesca Gany
- Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Memorial Sloan-Kettering Cancer Center, New York City, NY, USA
| | - Javier Gonzalez
- Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Memorial Sloan-Kettering Cancer Center, New York City, NY, USA
| | - Julia Ramirez
- Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Memorial Sloan-Kettering Cancer Center, New York City, NY, USA
| | - Sarah T Jewell
- Medical Library, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Lisa C Diamond
- Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Memorial Sloan-Kettering Cancer Center, New York City, NY, USA.
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Redwood D, Provost E, Lopez EDS, Skewes M, Johnson R, Christensen C, Sacco F, Haverkamp D. A Process Evaluation of the Alaska Native Colorectal Cancer Family Outreach Program. Health Educ Behav 2015; 43:35-42. [PMID: 26157041 DOI: 10.1177/1090198115590781] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
This article presents the results of a process evaluation of the Alaska Native (AN) Colorectal Cancer (CRC) Family Outreach Program, which encourages CRC screening among AN first-degree relatives (i.e., parents, siblings, adult children; hereafter referred to as relatives) of CRC patients. Among AN people incidence and death rates from CRC are the highest of any ethnic/racial group in the United States. Relatives of CRC patients are at increased risk; however, CRC can be prevented and detected early through screening. The evaluation included key informant interviews (August to November 2012) with AN and non-AN stakeholders and program document review. Five key process evaluation components were identified: program formation, evolution, outreach responses, strengths, and barriers and challenges. Key themes included an incremental approach that led to a fully formed program and the need for dedicated, culturally competent patient navigation. Challenges included differing relatives' responses to screening outreach, health system data access and coordination, and the program impact of reliance on grant funding. This program evaluation indicated a need for more research into motivating patient screening behaviors, electronic medical records systems quality improvement projects, improved data-sharing protocols, and program sustainability planning to continue the dedicated efforts to promote screening in this increased risk population.
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Affiliation(s)
- Diana Redwood
- Alaska Native Epidemiology Center, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Ellen Provost
- Alaska Native Epidemiology Center, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | | | | | | | - Claudia Christensen
- Alaska Native Epidemiology Center, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Frank Sacco
- Alaska Native Epidemiology Center, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Donald Haverkamp
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, NM, USA
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Burhansstipanov L, Harjo L, Krebs LU, Marshall A, Lindstrom D. Cultural roles of native patient navigators for american Indian cancer patients. Front Oncol 2015; 5:79. [PMID: 25984483 PMCID: PMC4415406 DOI: 10.3389/fonc.2015.00079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 03/17/2015] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Lisa Harjo
- Native American Cancer Research Corporation , Pine, CO , USA
| | - Linda U Krebs
- Anschutz Medical Campus, College of Nursing, University of Colorado at Denver , Denver, CO , USA
| | - Audrey Marshall
- Native American Cancer Research Corporation , Pine, CO , USA
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Ely GE, White C, Jones K, Feltner F, Gomez M, Shelton B, Slone S, Van Meter E, Desimone C, Schoenberg N, Dignan M. Cervical cancer screening: exploring Appalachian patients' barriers to follow-up care. Soc Work Health Care 2014; 53:83-95. [PMID: 24483330 PMCID: PMC5603223 DOI: 10.1080/00981389.2013.827149] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This article describes a community-based Patient Navigation (PN) project conducted to identify potential barriers to seeking follow-up cervical cancer care in southeastern Kentucky. Patient navigators (PNs) were placed in cervical cancer programs within county public health departments where they interviewed patients about their perceived barriers to seeking follow-up care after receiving a positive Pap test result. Participants identified various potential barriers at three levels: the individual/personal level, the health care system level and the community/environmental level. One identified barrier that was unique to this study was a lack of consistency between follow-up recommendations and follow-up guidelines for patients under age 21. Implications are discussed.
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Affiliation(s)
- Gretchen E Ely
- a College of Social Work , University of Kentucky , Lexington , Kentucky , USA
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Abstract
Background: Although the United States is one of the countries at the leading edge of medical breakthroughs and treatments, there are great disparities in the access to care among different socioeconomic strata. One of the most striking discrepancies regarding access to care is found among the ranks of the Hispanic population, which is the fastest growing minority in the United States, but for which cancer is the third leading cause of death. It is clear that better and timely treatment for cancer patients belonging to this minority is needed. Patient navigators can be an important tool to improve access to care of patients belonging to this minority group. Methods: Through a systemic search, we identified seven articles that employed patient navigators for Hispanic cancer patients. The identified studies addressed very limited pathology, three studying breast and four colon cancer patients. Conclusions: The presence of patient navigation can be an effective to remove impediments that limit the access to care in minority populations and can improve outcomes in Hispanic patients suffering from cancer. Further research to evaluate the cost of patient navigation in relationship to the added benefit early diagnosis, continued follow up and treatment is needed.
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Affiliation(s)
- Loreley Robie
- Department of Neurosurgery, University of California at Irvine, CA, USA
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Abstract
Only 50% of New Yorkers aged 50 and over reported ever being screened for colorectal cancer by any modality according to a recent household survey. The objective of this investigation was to assess the impact of a hospital-based intervention aimed at eliminating health care system barriers to timely colorectal cancer screening at Lincoln Medical Center, a large, urban public hospital in one of the nation's poorest census tracts. We conducted a retrospective analysis of all colonoscopies performed over an 11-month period, during which a multi-pronged intervention to increase the number of screening colonoscopies took place. Two "patient navigators" were hired during the study period to provide continuity for colonoscopy patients. A Direct Endoscopic Referral System (DERS) was also implemented. Enhancements to the gastrointestinal (GI) suite were also made to improve operational efficiency. Immediately following the introduction of the patient navigators, there was a dramatic and sustained decline in the broken appointment rates for both screening and diagnostic colonoscopy (from 67% in May of 2003 to 5% in June of 2003). The likelihood of keeping the appointment for colonoscopy after the patient navigator intervention increased by nearly 3-fold (relative risk = 2.6, 95% CI 2.2-3.0). The rate of screening colonoscopies increased from 56.8 per month to 119 per month. The screening colonoscopy coverage provided by this facility among persons aged 50 and over in surrounding Zip codes increased from 5.2 to 15.6% (RR 3.0, 95% CI 1.9-4.7). Efforts to increase the number of screening colonoscopies were highly successful, due in large part to the influence of patient navigators, a streamlined referral system, and GI suite enhancements. These findings suggest that there are significant health-care system barriers to colonoscopy that, when addressed, could have a significant impact on screening colonoscopy rates in the general population.
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Affiliation(s)
- Denis Nash
- Center for Urban Epidemiologic Studies, The New York Academy of Medicine, New York, NY, USA.
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