The role of patient navigators in ambulatory care: overview of systematic reviews

Abstract

Background Patient navigators have been introduced across various countries to enable timely access to healthcare services and to ensure completion of diagnosis and follow-up of care. There is an increasing evidence on the the role of patient navigation for patients and healthcare systems. The aim of this study was to analyse the evidence on patient navigation interventions in ambulatory care and to evaluate their effects on individuals and health system outcomes. Methods An overview of reviews was conducted, following a prespecified protocol. All patients in ambulatory care or transitional care setting were included in this review as long as it was related to the role of patient navigators. The study analysed patient navigators covering a wide range of health professionals such as physicians, nurses, pharmacists, social workers and lay health workers or community-based workers with no or very limited training. Studies including patient-related measures and health system-related outcomes were eligible for inclusion. A rigorous search was performed in multiple data bases. After reaching a high inter-rater agreement of 0.86, title and abstract screening was independently performed. Of an initial 14,248 search results and an additional 62 articles identified through the snowballing approach, a total of 7159 hits were eligible for title/abstract screening. 679 articles were included for full-text screening. Results Eleven systematic reviews were included covering various patient navigation intervention in cancer care, disease screening, transitional care and for various chronic conditions and multimorbidity. Nine systematic reviews primarily tailored services to ethnic minorities or other disadvantaged groups. Patient navigators performed tasks such as providing education and counselling, translations, home visits, outreach, scheduling of appointments and follow-up. Eight reviews identified positive outcomes in expanding access to care, in particular for vulnerable patient groups. Two reviews on patient navigation in transitional care reported improved patient outcomes, hospital readmission rates and mixed evidence on quality of life and emergency department visits. Two reviews demonstrated improved patient outcomes for persons with various chronic conditions and multimorbidity. Conclusions Patient navigators were shown to expand access to screenings and health services for vulnerable patients or population groups with chronic conditions who tend to underuse health services.

Patient Navigators for CKD and Kidney Failure: A Systematic Review

“…The most commonly performed tasks across populations and diseases in ambulatory care are education and counseling, translations, home visits, outreach, and scheduling. 24 In a systematic review of 67 studies of patient navigator programs for chronic diseases (44cancer, 8 diabetes, 7 HIV/AIDS, 4 cardiovascular disease, 2 CKD, 1 dementia, 1 multimorbidity), program design and implementation also varied considerably. This heterogeneity is presumably related to their definition of a patient navigator, which we also used, but which is not standardized clinically, in research or administratively.…”

Treatment Adherence in CKD and Support From Health care Providers: A Qualitative Study

“…Some clinical spaces have used care coordinators or patient navigators to fill the educational needs gap as a way to try to improve patient outcomes. 42 , 43 However, patient navigator programs remain underutilized, 44 and program evaluations infrequently assess patient experience, clinical outcomes, or costs. 45 …”

Evaluation of Telehealth Visit Attendance After Implementation of a Patient Navigator Program

“…Physicians at Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center, a major academic teaching hospital in Boston, Massachusetts, rapidly adopted telehealth but reported technical challenges during video visits and sometimes converted video visits to telephone. 1 Patient outreach has been suggested to facilitate successful video visits, 2 and during the launch of over 500 000 ambulatory telehealth visits at our medical center since the onset of the COVID-19 pandemic, we implemented a pilot program to address the transition from telephone to video visits.…”

“…Patient outreach has been suggested to facilitate successful video visits, 2 and during the launch of over 500 000 ambulatory telehealth visits at our medical center since the onset of the COVID-19 pandemic, we implemented a pilot program to address the transition from telephone to video visits. Patient navigators are typically identified as staff that guide patients in coordination of care, appointment adherence, and discharge planning.…”