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      Patient navigators for people with chronic disease: A systematic review

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          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 references99

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          Patient navigation: state of the art or is it science?

          First implemented in 1990, patient navigation interventions are emerging today as an approach to reduce cancer disparities. However, there is lack of consensus about how patient navigation is defined, what patient navigators do, and what their qualifications should be. Little is known about the efficacy and cost-effectiveness of patient navigation. For this review, the authors conducted a qualitative synthesis of published literature on cancer patient navigation. By using the keywords 'navigator' or 'navigation' and 'cancer,' 45 articles were identified in the PubMed database and from reference searches that were published or in press through October 2007. Sixteen studies provided data on the efficacy of navigation in improving timeliness and receipt of cancer screening, diagnostic follow-up care, and treatment. Patient navigation services were defined and differentiated from other outreach services. Overall, there was evidence of some degree of efficacy for patient navigation in increasing participation in cancer screening and adherence to diagnostic follow-up care after the detection of an abnormality. The reported increases in screening ranged from 10.8% to 17.1%, and increases in adherence to diagnostic follow-up care ranged from 21% to 29.2% compared with control patients. There was less evidence regarding the efficacy of patient navigation in reducing either late-stage cancer diagnosis or delays in the initiation of cancer treatment or improving outcomes during cancer survivorship. There were methodological limitations in most studies, such as a lack of control groups, small sample sizes, and contamination with other interventions. Although cancer-related patient navigation interventions are being adopted increasingly across the United States and Canada, further research will be necessary to evaluate their efficacy and cost-effectiveness in improving cancer care. (c) 2008 American Cancer Society.
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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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              Effectiveness of a community health worker intervention among African American and Latino adults with type 2 diabetes: a randomized controlled trial.

              We tested the effectiveness of a culturally tailored, behavioral theory-based community health worker intervention for improving glycemic control. We used a randomized, 6-month delayed control group design among 164 African American and Latino adult participants recruited from 2 health systems in Detroit, Michigan. Our study was guided by the principles of community-based participatory research. Hemoglobin A1c (HbA1c) level was the primary outcome measure. Using an empowerment-based approach, community health workers provided participants with diabetes self-management education and regular home visits, and accompanied them to a clinic visit during the 6-month intervention period. Participants in the intervention group had a mean HbA1c value of 8.6% at baseline, which improved to a value of 7.8% at 6 months, for an adjusted change of -0.8 percentage points (P < .01). There was no change in mean HbA1c among the control group (8.5%). Intervention participants also had significantly greater improvements in self-reported diabetes understanding compared with the control group. This study contributes to the growing evidence for the effectiveness of community health workers and their role in multidisciplinary teams engaged in culturally appropriate health care delivery.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: Writing – review & editing
                Role: Formal analysisRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: Project administrationRole: Writing – review & editing
                Role: MethodologyRole: VisualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Writing – review & editing
                Role: ValidationRole: Writing – review & editing
                Role: ValidationRole: Writing – review & editing
                Role: ValidationRole: Writing – review & editing
                Role: ConceptualizationRole: 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
                : e0191980
                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.

                Author information
                http://orcid.org/0000-0002-6024-7828
                Article
                PONE-D-17-23683
                10.1371/journal.pone.0191980
                5819768
                29462179
                7cf8abec-0c85-4b9b-942c-a725a0569a39
                © 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.

                History
                : 23 June 2017
                : 14 January 2018
                Page count
                Figures: 3, Tables: 2, Pages: 33
                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 :
                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.

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                Uncategorized

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