scholarly journals The Role of Patient Navigators in Ambulatory Care: Overview of Systematic Reviews

2021 ◽  
Author(s):  
Hannah Budde ◽  
Gemma Williams ◽  
Juliane Winkelmann ◽  
Laura Pfirter ◽  
Claudia Bettina Maier
Keyword(s):  
Health Services ◽  
Health System ◽  
Ambulatory Care ◽  
Systematic Reviews ◽  
Patient Navigation ◽  
Transitional Care ◽  
Emergency Department Visits ◽  
Patient Navigators

Abstract Background: Patient navigators have been introduced across various countries to enable timely access to healthcare services and ensure completion of diagnosis and follow-up of care. There is an increasing amount of evidence on the positive effect of patient navigation for patients. 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, based on 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 all roles of patient navigators covering a wide range of health professionals such as physicians, nurses, pharmacists, social workers as well as 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 data collection was performed in multiple data bases. After reaching an inter-rater agreement, title and abstract screening was independently performed. Of an initial 8362 search results a total of 673 articles were eligible for full-text screening. An extraction form was used to analyse the nine included review.Results: Nine systematic reviews were included covering various patient navigation roles in cancer care, disease screening and transitional care. Seven 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. Six 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 and hospital readmission rates and mixed evidence on quality of life and emergency department visits.Conclusions: Patient navigators have shown to expand access to screenings and health services for vulnerable patients or population groups who tend to underuse health services.

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

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hannah Budde ◽  
Gemma A. Williams ◽  
Juliane Winkelmann ◽  
Laura Pfirter ◽  
Claudia B. Maier
Keyword(s):  
Ambulatory Care ◽  
Patient Outcomes ◽  
Systematic Reviews ◽  
Chronic Conditions ◽  
Patient Navigation ◽  
Transitional Care ◽  
Patient Navigators ◽  
Abstract Screening

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.

Innocuous presentation of ameloblastic carcinoma

2021 ◽  
Vol 14 (12) ◽  
pp. e246907
Author(s):  
Swagatika Panda ◽  
Rupsa Das ◽  
Diksha Mohapatra ◽  
Neeta Mohanty
Keyword(s):  
Systematic Reviews ◽  
Adjuvant Radiotherapy ◽  
Case Reports ◽  
Differential Diagnoses ◽  
Ameloblastic Carcinoma ◽  
Histopathological Evaluation ◽  
Odontogenic Neoplasm

Ameloblastic carcinoma is a rare malignant odontogenic neoplasm that exhibits diverse clinical and radiological presentations. In fact there are several differential diagnoses during histopathological evaluation too. Lack of adequate reports could not establish the predominant demographic, clinical and radiological presentations. For the same reasons, the role of adjuvant radiotherapy and chemotherapy is also unsubstantiated yet. This case discusses the innocuous clinical and radiological presentation of ameloblastic carcinoma in a 55-year-old man where the diagnostic confirmation was achieved through histopathological evaluation. The differential diagnoses, treatment and follow-up details of this case are discussed in light of the previous published case reports and systematic reviews of case reports in an attempt to increase the sensitisation among dentists towards ameloblastic carcinoma.

Quality

2020 ◽  
pp. 166-183
Author(s):  
Julie Sin
Keyword(s):  
Health Services ◽  
Health System ◽  
Services Quality ◽  
Quality Care ◽  
System Level ◽  
Quality Of Services ◽  
Provider Perspective ◽  
Multidimensional Concept

This chapter looks at the topic of health services quality from a commissioning and whole population perspective. Quality is noted to be a multidimensional concept and dimensions of quality are considered. The role of the commissioner in maintaining and improving quality of services is explored, and this is seen within a wider backdrop of a health system with commissioner and provider functions (if there are such distinctions in the system). Commissioners need to know whether they are securing quality care for their population for the money spent. They also need an understanding of how this dovetails with the provider perspective on this topic. Commissioners also need to be able to articulate what they wish to assess in practice under the guise of quality. Finally, at a system level there are also bearings on how to compile and interpret a picture of a population’s health if needed.

Impact of a Student Pharmacist Pilot Focused on the Transitions of Care Process From Emergency Department Visits to Family Medicine Follow-Up in a Rural Patient Setting

2020 ◽  
pp. 089719002090546
Author(s):  
Christina E. DeRemer ◽  
Shannon R. Lyons ◽  
Emily J. Harman ◽  
Karina Quinn ◽  
Jason Konopack
Keyword(s):  
Emergency Department ◽  
Family Medicine ◽  
Care Management ◽  
Transitional Care ◽  
Emergency Department Visits ◽  
Care Process ◽  
Emergency Department Utilization ◽  
Primary Physician ◽  
Rural Family

Introduction: Few would argue that emergency department utilization volumes do not tax the health system. Currently, there is not a process defined by Centers for Medicare and Medicaid Services for transitioning this patient population back to their primary physicians following emergency department visits. Resource limitations in a rural family medicine setting create barriers to dedicate focus on this important transitional care management from urgent care visits to primary care office. Objective: To describe a novel pilot process for transitional care management from the emergency department utilizing pharmacy student extenders to overcome resource limitation at a rural family medicine clinic and establish follow-up primary physician contact. Methods: From a master list provided, student pharmacists proactively telephoned patients and reviewed medication changes while assisting with scheduling follow-up appointments at the patient’s primary physician clinic. Results: The result of these efforts increased the communication with patients and resulted in a 26% (10/38) increase in follow-up appointments scheduled with a total increase of an additional 7 patients adhering to follow-up transitional appointment. Conclusion: This approach utilizing student extenders is a feasible and sustainable process that can increase patient contact when resources are limited, while serving as an educational tool for next generation providers.

scholarly journals Quantifying comorbidity in individuals with COPD: a population study

2014 ◽  
Vol 45 (1) ◽  
pp. 51-59 ◽  
Author(s):  
Andrea S. Gershon ◽  
Graham C. Mecredy ◽  
Jun Guan ◽  
J. Charles Victor ◽  
Roger Goldstein ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cardiovascular Disease ◽  
Emergency Department ◽  
Tract Infection ◽  
Health Services ◽  
Respiratory Tract ◽  
Ambulatory Care ◽  
Respiratory Tract Infection ◽  
Lower Respiratory Tract ◽  
Emergency Department Visits

Chronic obstructive pulmonary disease (COPD) has been associated with many types of comorbidity. We aimed to quantify the real world impact of COPD on lower respiratory tract infection, cardiovascular disease, diabetes, psychiatric disease, musculoskeletal disease and cancer, and their impact on COPD through health services.A population study using health administrative data from Ontario, Canada, in 2008–2012 was conducted. Absolute and adjusted relative rates of ambulatory care visits, emergency department visits and hospitalisations for the comorbidities of interest in people with and without COPD were determined and compared.Among 7 241 591 adults, 909 948 (12.6%) had COPD. Over half of all lung cancer, a third of all lower respiratory tract infection and cardiovascular disease, a quarter of all low trauma fracture, and a fifth of all psychiatric, musculoskeletal, non-lung cancer and diabetes ambulatory care visits, emergency department visits and hospitalisations in Ontario were used by people with COPD. Individuals with COPD used about five times more health services for lung cancer, and two times more health services for lower respiratory tract infections and cardiovascular disease than people without COPD.Individuals with COPD use a disproportionate amount of health services for comorbid disease, placing significant burden on the healthcare system.

The role of a geriatrician in a cancer center.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 39-39 ◽  
Author(s):  
Beatriz Korc-Grodzicki ◽  
Sung W. Sun ◽  
Armin Shahrokni ◽  
Koshy Alexander ◽  
Soo Jung Kim ◽  
...  
Keyword(s):  
Older Adults ◽  
Risk Assessment ◽  
Nurse Practitioners ◽  
Transitional Care ◽  
Unmet Need ◽  
Cancer Center ◽  
Ongoing Research ◽  
Increased Risk

39 Background: Older adults are likely to have coexisting health conditions, polypharmacy and functional limitations. The geriatrician may have a pivotal role in risk assessment, prevention and treatment of comorbidities and addressing geriatric syndromes. The purpose of this study is to describe the growth and development of, and the role of a Geriatrics Service (GS) in a cancer center. Methods: A GS was founded in MSKCC in 2009. Since then it has grown to provide inpatient (IP) and outpatient (OP) care for older adults undergoing cancer diagnosis, surveillance or active treatment. It offers preoperative evaluations, geriatric assessment (GA) and follow-up shared- care. Recently, a Transitional Care Management (TCM) program was established for patients at increased risk of rehospitalization. The GS strives to develop an interprofessional educational geriatrics curriculum and to participate in quality and research projects focused on cancer and aging. Results: Between 2009 and 2014 a total of 6679 new patients were evaluated by the GS. 16% of the patients were 65-75, 70% were 76-85 and 14% were older than 85. 46% were male and 84% were white. 15% were IP and 85% were OP consultations. 13% of the OP consults were for GA, the rest were preoperative evaluations. All patients seen preoperatively who are admitted after surgery, are followed postoperatively by the IP geriatrics team. In total, 4 Geriatricians, 2 Geriatric Nurse Practitioners (GNP) and 3 RNs were recruited. The number of follow-up visits increased from 143 in 2009 to 733 in 2014. The new TCM program based on close communication between the IP and OP GNP has been successful in keeping frail patients from frequent rehospitalizations. Noon conferences on geriatrics for the house staff, a biannual course on “Advancing Nursing Expertise in the Care of Older Adults with Cancer” and a monthly interprofessional meeting for the discussion of Geriatric Clinical Complex Cases (GCCC) are ongoing. Research has focused on risk assessment and the use of telemedicine in geriatric patient care. Conclusions: The establishment of a GS in a cancer center was very well received and embraced by the oncologists showing an unmet need in the care of the older cancer patient. The potential reproducibility beyond the cancer center will be discussed.

Applying the evidence to your patient: The role of systematic reviews in your knowledge tool box

2020 ◽  
Vol 13 (12) ◽  
pp. 747-753
Author(s):  
David Tovey
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
Knowledge Resource

This article explores how systematic reviews can provide a useful addition to a general practitioner’s knowledge toolbox and explores scenarios where systematic reviews can be used to help inform a decision. The article also explores how the trustworthiness of the information from a systematic review or indeed any knowledge resource, can be assessed, and describes some of the ways that systematic reviews are changing. A follow up article will explore, in more detail, how to appraise, understand and use the information in a systematic review.

scholarly journals Minimally Adequate Mental Health Treatment and Mortality in Primary Care Older Adults With Depression and Anxiety

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 864-865
Author(s):  
Helen-Maria Vasiliadis ◽  
Catherine Lamoureux-Lamarche ◽  
Sébastien Grenier ◽  
Pasquale Roberge
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Primary Care ◽  
Health System ◽  
Emergency Department Visits ◽  
Adequate Treatment ◽  
Risk Of Mortality ◽  
Follow Up Care ◽  
System Factors

Abstract Receipt of quality mental health (MH) care can influence mortality. Given the scarce literature on the topic, the aim was to assess the 3-year risk of mortality in older adults (OA) associated with receiving adequate MH treatment for depression/anxiety in an epidemiologic context. The study sample included 358 OA with depression/anxiety recruited in primary care practices and followed prospectively for 3 years. Mortality was assessed from vital statistics data. Adequate care was based on receipt of pharmacotherapy, follow-up care and psychotherapy. Propensity score analysis was carried out where the inverse probability (IPW) of receiving adequate treatment was calculated. Time to event analyses with IPW was used to assess the effect of receipt of adequate MH treatment on the risk of mortality controlling for individual and health system factors. The results showed that receipt of adequate MH treatment reduced the risk of mortality (HR0.44; 95% CI: 0.22 – 0.99). Individual factors that increased mortality were male sex, being single, reduced functional status and cognitive functioning, # physical disorders, current smoking; while exercise reduced risk. Health system factors such as past # of hospitalizations increased the risk; while # of emergency department visits and continuity of care reduced mortality. Finally, treating depression/anxiety with minimal follow-up care and pharmacotherapy or psychotherapy has a significant impact on reducing mortality in OA. Primary care physicians should recognize the important potential impact of years of lives saved when providing quality MH care to OA.

The transition from treatment to follow-up care: A critical time for patient navigation.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 83-83
Author(s):  
Sam Gaster ◽  
Rita Sanem ◽  
Diane Jones-Larson ◽  
Jordan Fiegen ◽  
Jamie Arens
Keyword(s):  
Cancer Care ◽  
Patient Navigation ◽  
Critical Time ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Successful Implementation ◽  
Long Term Effects ◽  
Patient Navigators ◽  
Follow Up Care

83 Background: There are many points of transition in cancer care, and each presents a unique set of challenges for patients and providers (Nekhlyudov, Levit, Hurria, & Ganz, 2014). This includes the transition from treatment to follow-up care, or the transition to survivorship. For patients, challenges include the need for continued support, education, and communication with the cancer care team. For providers, challenges include the management of late- and long-term effects, modification of health behaviors, and coordination with other providers (IOM, 2005). These challenges can be overcome with patient navigation services. However, survivors’ access to these services is not universal. This evaluation describes the implementation and assessment of these services at six regional cancer centers in the Midwest. Methods: Key stakeholders designed a protocol for survivors to receive patient navigation after their transition to follow-up care. These navigation services are provided by nurse and social work navigators, and involve placing outbound calls to survivors. These contacts occur approximately two weeks after survivors receive a survivorship care plan (SCP) and a needs assessment. Results: From August through September 2016, 33 (91.67%) survivors were contacted by patient navigators. Three survivors could not be reached. Twenty-one percent (n = 7) of survivors contacted had not previously received navigation services. However, all survivors contacted received navigation services that would not otherwise been provided. Contacted survivors expressed high satisfaction with the services, and the most common needs addressed were anxiety and fatigue. Conclusions: Results support the value of patient navigation services for cancer survivors. This evaluation describes the successful implementation of a protocol for the continued navigation of survivors after their transition to follow-up care. Results encourage further development and evaluation of this protocol, including its impact on symptom management, health promotion, and care coordination via referrals and the provision of education and resources.

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