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      Patient navigators for people with chronic disease: A systematic review

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background

          People with chronic diseases experience barriers to managing their diseases and accessing available health services. Patient navigator programs are increasingly being used to help people with chronic diseases navigate and access health services.

          Objective

          The objective of this review was to summarize the evidence for patient navigator programs in people with a broad range of chronic diseases, compared to usual care.

          Methods

          We searched MEDLINE, EMBASE, CENTRAL, CINAHL, PsycINFO, and Social Work Abstracts from inception to August 23, 2017. We also searched the reference lists of included articles. We included original reports of randomized controlled trials of patient navigator programs compared to usual care for adult and pediatric patients with any one of a defined set of chronic diseases.

          Results

          From a total of 14,672 abstracts, 67 unique studies fit our inclusion criteria. Of these, 44 were in cancer, 8 in diabetes, 7 in HIV/AIDS, 4 in cardiovascular disease, 2 in chronic kidney disease, 1 in dementia and 1 in patients with more than one condition. Program characteristics varied considerably. Primary outcomes were most commonly process measures, and 45 of 67 studies reported a statistically significant improvement in the primary outcome.

          Conclusion

          Our findings indicate that patient navigator programs improve processes of care, although few studies assessed patient experience, clinical outcomes or costs. The inability to definitively outline successful components remains a key uncertainty in the use of patient navigator programs across chronic diseases. Given the increasing popularity of patient navigators, future studies should use a consistent definition for patient navigation and determine which elements of this intervention are most likely to lead to improved outcomes.

          Trial registration

          PROSPERO # CRD42013005857

          Related collections

          Most cited references 104

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          Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008.

          Estimates of the worldwide incidence and mortality from 27 cancers in 2008 have been prepared for 182 countries as part of the GLOBOCAN series published by the International Agency for Research on Cancer. In this article, we present the results for 20 world regions, summarizing the global patterns for the eight most common cancers. Overall, an estimated 12.7 million new cancer cases and 7.6 million cancer deaths occur in 2008, with 56% of new cancer cases and 63% of the cancer deaths occurring in the less developed regions of the world. The most commonly diagnosed cancers worldwide are lung (1.61 million, 12.7% of the total), breast (1.38 million, 10.9%) and colorectal cancers (1.23 million, 9.7%). The most common causes of cancer death are lung cancer (1.38 million, 18.2% of the total), stomach cancer (738,000 deaths, 9.7%) and liver cancer (696,000 deaths, 9.2%). Cancer is neither rare anywhere in the world, nor mainly confined to high-resource countries. Striking differences in the patterns of cancer from region to region are observed. Copyright © 2010 UICC.
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            Global estimates of the prevalence of diabetes for 2010 and 2030.

            We estimated the number of people worldwide with diabetes for the years 2010 and 2030. Studies from 91 countries were used to calculate age- and sex-specific diabetes prevalences, which were applied to national population estimates, to determine national diabetes prevalences for all 216 countries for 2010 and 2030. Studies were identified using Medline, and contact with all national and regional International Diabetes Federation offices. Studies were included if diabetes prevalence was assessed using a population-based methodology, and was based on World Health Organization or American Diabetes Association diagnostic criteria for at least three separate age-groups within the 20-79 year range. Self-report or registry data were used if blood glucose assessment was not available. The world prevalence of diabetes among adults (aged 20-79 years) will be 6.4%, affecting 285 million adults, in 2010, and will increase to 7.7%, and 439 million adults by 2030. Between 2010 and 2030, there will be a 69% increase in numbers of adults with diabetes in developing countries and a 20% increase in developed countries. These predictions, based on a larger number of studies than previous estimates, indicate a growing burden of diabetes, particularly in developing countries. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.
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              Improving the quality of health care in the United Kingdom and the United States: a framework for change.

              Fueled by public incidents and growing evidence of deficiencies in care, concern over the quality and outcomes of care has increased in both the United Kingdom and the United States. Both countries have launched a number of initiatives to deal with these issues. These initiatives are unlikely to achieve their objectives without explicit consideration of the multilevel approach to change that includes the individual, group/team, organization, and larger environment/system level. Attention must be given to issues of leadership, culture, team development, and information technology at all levels. A number of contingent factors influence these efforts in both countries, which must each balance a number of tradeoffs between centralization and decentralization in efforts to sustain the impetus for quality improvement over time. The multilevel change framework and associated properties provide a framework for assessing progress along the journey.
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                Author and article information

                Affiliations
                [1 ] Departments of Family Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
                [2 ] Department of Family and Community Medicine, Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada
                [3 ] Department of Medicine, University of Calgary, Calgary, Alberta, Canada
                [4 ] W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
                [5 ] Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
                [6 ] Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
                [7 ] Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
                [8 ] Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Alberta, Canada
                [9 ] Department of Family Medicine, Alberta Health Services, Calgary, Alberta, Canada
                TNO, NETHERLANDS
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Contributors
                ORCID: http://orcid.org/0000-0002-6024-7828, Role: Conceptualization, Role: Formal analysis, Role: Investigation, Role: Methodology, Role: Visualization, Role: Writing – original draft, Role: Writing – review & editing
                Role: Conceptualization, Role: Methodology, Role: Writing – review & editing
                Role: Formal analysis, Role: Methodology, Role: Writing – original draft, Role: Writing – review & editing
                Role: Data curation, Role: Formal analysis, Role: Project administration, Role: Writing – review & editing
                Role: Methodology, Role: Visualization, Role: Writing – review & editing
                Role: Conceptualization, Role: Writing – review & editing
                Role: Conceptualization, Role: Writing – review & editing
                Role: Conceptualization, Role: Writing – review & editing
                Role: Validation, Role: Writing – review & editing
                Role: Validation, Role: Writing – review & editing
                Role: Validation, Role: Writing – review & editing
                Role: Conceptualization, Role: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                20 February 2018
                2018
                : 13
                : 2
                PONE-D-17-23683
                10.1371/journal.pone.0191980
                5819768
                29462179
                © 2018 McBrien et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Counts
                Figures: 3, Tables: 2, Pages: 33
                Product
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100000145, Alberta Innovates - Health Solutions;
                Award Recipient :
                Funded by: Canadian Diabetes Association (CA)
                Award Recipient : ORCID: http://orcid.org/0000-0002-6024-7828
                This research was funded by an Alberta Innovates – Health Solutions (AI-HS) team grant to the Interdisciplinary Chronic Disease Collaboration (ICDC), project ID #10007987 ( http://albertainnovates.ca/) to Brenda Hemmelgarn and the Canadian Diabetes Association (CA) to Kerry A McBrien. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Diagnostic Medicine
                Cancer Detection and Diagnosis
                Cancer Screening
                Medicine and Health Sciences
                Oncology
                Cancer Detection and Diagnosis
                Cancer Screening
                Medicine and Health Sciences
                Public and Occupational Health
                Health Screening
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Medicine and Health Sciences
                Women's Health
                Biology and Life Sciences
                Genetics
                Gene Identification and Analysis
                Genetic Screens
                Engineering and Technology
                Equipment
                Communication Equipment
                Telephones
                Biology and Life Sciences
                Psychology
                Psychometrics
                Social Sciences
                Psychology
                Psychometrics
                Medicine and Health Sciences
                Health Care
                Communication in Health Care
                Custom metadata
                All relevant data are within the paper and its Supporting Information files.

                Uncategorized

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