Navigation delivery models and roles of navigators in primary care: a scoping literature review

Abstract

BackgroundSystems navigation provided by individuals or teams is emerging as a strategy to reduce barriers to care. Complex clients with health and social support needs in primary care experience fragmentation and gaps in service delivery. There is great diversity in the design of navigation and a lack of consensus on navigation roles and models in primary care.MethodsWe conducted a scoping literature review following established methods to explore the existing evidence on system navigation in primary care. To be included, studies had to be published in English between 1990 and 2013, and include a navigator or navigation process in a primary care setting that involves the community- based social services beyond the health care system.ResultsWe included 34 papers in our review, most of which were descriptive papers, and the majority originated in the US. Most of the studies involved studies of individual navigators (lay person or nurse) and were developed to meet the needs of specific patient populations. We make an important contribution to the literature by highlighting navigation models that address both health and social service navigation. The emergence and development of system navigation signals an important shift in the recognition that health care and social care are inextricably linked especially to address the social determinants of health.ConclusionsThere is a high degree of variance in the literature, but descriptive studies can inform further innovation and development of navigation interventions in primary care.

Supporting social prescribing in primary care by linking people to local assets: a realist review

“…To the best of our knowledge, no previous systematic synthesis of existing literature, using a realist lens, has explored how this role can be implemented optimally. Other reviews have looked more at clinical navigation, rather than the use of local assets to address social determinants of health [34,35], have not adopted a realist lens when working with data [36][37][38] or have not focused specially on connector schemes [39]. A realist review that explored social prescribing more broadly described link workers as essential but not enough, on their own, to ensure that desired outcomes are achieved [15]; other elements, as touched on in our review, need to be in place, such as a vibrant VCS, changing the medical model focus in some health settings, and a shift in the mindset of patients.…”

An integrated hospital-to-home transitional care intervention for older adults with stroke and multimorbidity: A feasibility study

“…While there is no commonly accepted definition of system navigation, we considered system navigation to refer to an individual or a team engaging in specific activities that include the following concepts: (i) facilitating access to health-related programs and social services for patients/families and caregivers; (ii) promoting and facilitating continuity of care; (iii) identifying and removing barriers to care; and (iv) effective and efficient use of the health-care system for both patients/families, caregivers, and practitioners. 44 A recent scoping review involving 34 studies on system navigation reported that because of the diversity of navigation models in the literature, and the lack of suitable research designs, it is difficult to draw conclusions regarding the effectiveness of system navigation. 44 However, one study was found that demonstrated the effectiveness of a Stroke Navigator role in increasing access to comprehensive, strengths-based assessment, planning, and referral facilitation.…”

Exploration of volunteers as health connectors within a multicomponent primary care‐based program supporting self‐management of diabetes and hypertension

“…Volunteers could work as extensions of primary care teams by: establishing stable relationships with patients, helping motivate lifestyle change and helping patients navigate the healthcare system. Helping motivate behaviour change through counselling techniques and peer support is common among health promotion volunteer programs (Crane-Okada et al, 2012;Ginis et al, 2013;Webel et al, 2010;Wu et al, 2012), while system navigation has become an increasingly recognised set of activities in primary care (Carter et al, 2018;Valaitis et al, 2017) and other settings (Manderson, McMurray, Piraino, & Stolee, 2012;Pedersen & Hack, 2010). Some navigation activities are best carried out by professionals, yet some (e.g.…”