Abstract
BackgroundPatient 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.MethodsAn 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.ResultsEleven 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.ConclusionsPatient 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.
Highlights
Introduction of patientIntervention: Cancer patients from United States (US) navigator to overcomeLay persons, nurses with medically underserved obstacles such as language oncology experience, populations, rural or barriers, coordination of individual with master in urban area, uninsured appointments, lack of social work persons, non-English transportation and Comparison: speaking persons insurance or difficulties to Not reported understand the follow-up process Improved adherence to follow-up Earlier treatment and treatment initiation Significant improvements in diagnostic resolution [28]Patient navigator intervention to improve screening, diagnosis and treatment of cancer in ethnic minority patientsEthnic minority cancer USNurses, lay health patients educators, lay health workers, NPs, community health aides, physicians Not reported Improved adherence to screening
Characteristics of the reviews included A total of 11 systematic reviews describing 311 individual studies on patient navigation roles met the inclusion criteria
The included reviews covered four areas of care: five systematic reviews analysed patient navigator roles for patients with various types of cancer (‘cancer care’ including diagnosis and treatment), six reviews focused on screenings for the prevention and early identification of diseases, two reviews covered transitional care interventions and two reviews included patient navigator interventions for various chronic conditions and multimorbidity
Summary
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. Access to healthcare services is vital to meet patients’ needs, decrease health inequalities and prevent diseases or slow disease progression and the development of complications. Throughout their care pathway, many patients see themselves confronted with a fragmented and complex healthcare system and navigating through it poses a challenge [6]. To enhance access to health care and strengthen coordination and continuity of care, various countries have introduced new professional roles and tasks, such as patient navigator roles [7].
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