Importance of Patient Navigation Program in Public Health

Sundar Dhoka Saathi Sewa (SDSS), a non-government organization, provides a patient navigation service which facilitates referrals to tertiary centers from Nepal’s most remote areas.The SDSS staff meet patients upon arrival in Kathmandu and facilitate admission to the appropriate tertiary hospital. They advocate for the patient, provide medicine, supply food and cover all Treatment. Injury and disability are prominent public health concerns, globally and in the country of Nepal. Lack of locally available medical infrastructure, socioeconomic barriers, social marginalization, poor health literacy, and cultural barriers prevent patients from accessing surgical and rehabilitative care. Overcoming these barriers is an insurmountable challenge for the most vulnerable and marginalized, resulting in absence of treatment or even death.

This patient navigation  project has enabled access to treatment for more than 1200 children for conditions leading to long-term disability and/or congenital heart disease. Interventions include a wide range of surgical and rehabilitative procedures such as complex orthopedics, cleft lip and palate, congenital talipes equinovarus, burn contractures, neurological cases, and cardiac surgery for valvular disease, septal defects and other congenital malformations.

The SDSS model of patient navigation is effective in overcoming the barriers to access surgical care and rehabilitation in Nepal.with this navigation program patients are getting benefit in rural area.

Refrence 

//link.springer.com/article/10.1007/s00268-021-06035-1

Patient navigation system involves patient navigators who guides the patients through the health care system and help them overcome the barriers that prevent them from getting the care they need. India is a developing country , and there are many people who are not well educated so they face difficulties in getting proper treatment because of the lack of guidance and knowledge. Therefore, patient navigation system is a very important aspect of health care. The basic aim of public health is to prevent diseases , promote health and prolong life. Through patient navigation system the process of detection of a disease becomes very timely and since it helps in the early detection of diseases in most of the cases , the person who is suffering gets cured. Therefore we can say that it is preventing diseases, prolonging life and promoting health and in turn promoting the importance of public health.

This Patient Navigation Program - KEVAT is the first in India to focus on an emerging patient navigation model that can be applied across all cancer care institutions. The program shall empower the navigators to:

• Build knowledge base in patient navigation in oncology with adept understanding of medical terminologies & assimilate understanding on cancer and its treatment protocols, supportive care options, including risks and benefits of integrative therapies, rehabilitation, funding options, insurance and other patient allied services; along with honing skill set for developing and implementing patient navigation programs in hospitals.
• Garner perspective on principles and operations of health systems, concepts of evidence-based information on cancer screening, diagnosis, treatment and survivourship
• Actively manage and devise follow-up practices & use evaluation metrics (patient encounters, patient feedback and overcoming barriers to care) to improve hospital systems to ensure better patient compliance and outcomes
• Advocate for quality and optimal patient care systems and improving healthcare delivery through appropriate resource planning and management
• Bring about attitudinal change in concept of care with a common vision and mission to offer best socio-economic support and strike equitable balance with limited resources.

//tmc.gov.in/index.php/en/kevat-patient-navigator

Patient navigators play a vital role in the accessibility, availability, and follow up of health care services to the public based on where they live, their country, their situation, and their professional capability and authority. As a patient navigator in public health, there is some important task that has been never neglected during navigation are: identify individual needs and barriers to care; education and counseling to patient and community, act as a linkage between the patient to different care providers based on their need; making appointments, setting reminders, and follow up as needed. Most importantly, patient navigation programs were initiated across the globe in main three areas of care such as cancer care, transitional care; care between ambulatory and inpatient care, care between different providers, and care between hospital to home, etc., and Services targeted at vulnerable and socially disadvantaged patients. (Budde et al., 2022)

The Patient Navigation Research Program was conducted among 10521 participants with the abnormal screening test and 2105 with cancer or pre-cancer diagnosis in 10 centers to compare patient navigation with usual care on time to diagnosis or treatment for participants with breast, cervical, colorectal, or prostate screening abnormalities and/or cancers from 2007 to 2010. The study showed that there was no benefit of patient navigation during first 90 days of care, but the benefit of navigation was found from 91 onwards for both diagnostic resolution (aHR = 1.51, P < .001)) and treatment initiation (aHR = 1.43, P < .007). In conclusion, patient navigation plays an important role in diagnostic resolution and treatment initiations despite the chances of loss to follow-up in cancer treatment. (Freund et al., 2014).

Budde H, Williams GA, Scarpetti G,  Kroezen M, Maier CB.(2022). What are patient navigators and how can they improve integration of care?.European Observatory on Health System and Policies

Freund KM, Battaglia TA, Calhoun E, Darnell JS, Dudley DJ, Fiscella K, Hare ML, LaVerda N, Lee JH, Levine P, Murray DM. Impact of patient navigation on timely cancer care: the Patient Navigation Research Program. Journal of the National Cancer Institute. 2014 Jun 1;106(6):dju115. Available from //doi.org/10.1093/jnci/dju115

A care paradigm called patient navigation seeks to increase access to care by making it simpler to find social, educational, and health services across the spectrum of care and care locations. The results of this scoping review offer implementation ideas for PNPs in several international healthcare settings. For the best execution, solutions for practical and logistical problems must be created.

Read more: //www.ncbi.nlm.nih.gov/pmc/articles/PMC8287353/

Patient Navigation is very important to facilitate the treatment process. It will ease the patient to know the process and challenges coming during the treatment process.

The study done on Implementation factors for the Patient Navigation:  //implementationsciencecomms.biomedcentral.com/articles/10.1186/s43058-021-00248-0

Strengthening coordination of care is crucial in delivering high quality and person-centred care with growing number of people being affected by chronic diseases and multimorbidities.

Patient navigation helps patients to navigate through the complexity of healthcare, identify the individual needs and barriers to care, educating patients and entire communities, linking patients with different care providers making appointments and setting reminders. They are also associated with positive outcomes in terms of increasing the access to care, reducing waiting times for diagnosis and treatment and increasing the uptake of screening and also contribute to improving care coordination and continuity of care by improved referrals and adherence to follow up.

Reference:

//apps.who.int/iris/rest/bitstreams/1404871/retrieve

Patient navigation represents an evidence-based health care intervention designed to enhance patient-centered care and care coordination. Investigators at 6 National Cancer Institute-designated cancer centers outline their approaches to reducing health care disparities and synthesize their efforts to ensure sustainability and successful transferability in the management of patients with cancer and their families in real-world health care settings.

//acsjournals.onlinelibrary.wiley.com/doi/10.1002/cncr.34251

The cornerstone of the public health is to prolong the life of the people with full quality of life. It emphasizes the patient-centered approach. Patient navigation program aims to overcome the barrier for accessing the care for patient compliances and outcomes. Thus patient navigation program plays an important role in public health. Patient navigation program sets out the knowledges of the patients for adept understanding of the medical terminologies, supportive care options, the risks and benefits of the integrative therapies, rehabilitation, insurance and other allied patient services. This program gathers the intuitions on health systems principles and operations, knowledges of evidence-based information on cancer screening, diagnosis and treatment. It improves the healthcare delivery by managing the resource allocation properly. It advocates for best qualitative patient care systems. It alters the attitudes with the concepts of care in common mission and vision to support best socio-economic approach and equity within the limited resources.

Patients and their caregivers often experience barriers to timely & quality treatment deliver. These barriers can include lack of experience with the healthcare system, inadequate health insurance, and challenges with day-to-day activities such as transportation to treatment and taking time off from work.

Patient navigation is an intervention that can improves public health outcomes.

Patient navigators provide evidence-based, unbiased information that helps patients understand their diagnosis and make educated treatment decisions and connect them with programs and services that offer hope, support, and tangible help as they navigate their health care experience.

Patient navigators can help reduce disparities in health care, increase patient satisfaction, and improve health outcomes.

Patient navigation programme guide patients to avail seamless health care services. patient navigation reduced the time to diagnosis and treatment, improved treatment adherence, patient quality of life, patient knowledge regarding their morbidity and their communication with their healthcare team.

Thus, Patient navigation programme minimize barriers to access the healthcare.

Research demonstrates that navigation can improve access to the cancer care system by addressing barriers, as well as facilitating quality care.

Patient navigation helps people get the health care and other resources they need to be as healthy as possible. Patient navigators work with people, their families, and their caregivers to overcome barriers to cancer screening and diagnosis, cancer care, and resources needed after cancer treatment, Patient navigators guide patients through the health care system and help them overcome barriers that prevent them from getting the care they need.

• //www.cdc.gov/screenoutcancer/patient-navigation.htm#:~:text=Patient%20navigation%20helps%20people%20get,resources%20needed%20after%20cancer%20treatment.

Patient navigation is rapidly growing and evolving healthcare profession. The need for patient navigation has been greater, the role of patient navigator and scope of practice has been ill-defined until now. 

Patient navigation is an intervention that can help increase treatment adherence and improve the health outcomes for cancer patients. Cancer patients and their caregivers often experience barriers to get the high quality treatment timely. these barriers may be lack of experience, difficulty in taking time off from work, inadequate resources, inadequate health insurances, challenges in day-to-day activity. Patient navigators helps to reduce the disparities in health care, increase patients satisfaction, and improve health outcomes.

Patient navigators can not only facilitate improved health care access and quality of underserved population through advocacy and care coordination, but they can also address deep-rooted issues related to distrust in providers and the health system that often lead to avoidance of health problem and non-compliance with treatment recommendation.

Reference:

Journal of oncology navigation and survivorship. The official journal of the academy of oncology nurse and patient navigation. //www.jons-online.com

The role of patient navigators in eliminating health disparities. ncbi.nlm.nih.gov http.//www.ncbi.nlm.nih.gov

Patient navigators are often targeted toward patients from vulnerable or marginalized populations that frequently experience the largest barriers to accessing health care. These include ethnic minorities, older people, socioeconomically disadvantaged groups, or uninsured persons. It may also improve patients’ health outcomes and lower readmission rates for patients with other chronic conditions and multimorbidity. This relates to the definition of the scope of practice and the effectiveness of supervision, qualification, and skills of patient navigators, and how the patient navigator role should be tailored for different patients and population groups.

In my opinion, Patient navigators can play a tremendous role to enhance access to UHC  and thus resulting in less out-of-pocket expenditure.

Reference

//gh.bmj.com/content/7/Suppl_6/e009526

Patient navigation is an intervention that can help increase treatment adherence and improve health outcomes for cancer patients. Cancer patients and their caregivers often experience barriers to timely, high-quality cancer treatment. These barriers can include lack of experience with the healthcare system, inadequate health insurance, and challenges with day-to-day activities such as transportation to treatment and taking time off from work. Patient navigators can help reduce disparities in cancer care, increase patient satisfaction, and improve health outcomes. This paper describes the benefits of patient navigation with a focus on the value of the nonclinical patient navigator and will also highlight the evidence base for patient navigation as an effective intervention in the clinical setting.

Patient navigation is one strategy to help address barriers to accessing timely, high-quality cancer care. We know that patient navigation is an effective intervention not only to help increase cancer screening rates but also to help cancer patients navigate the healthcare system. In recent years, 2 types of navigation have emerged—clinical navigation and nonclinical patient navigation. This article will focus on the nonclinical patient navigation role. The nonclinical navigator is a trained professional who provides individualized assistance to patients, families, and caregivers to help overcome barriers to timely access to quality cancer care

Reference:jons.online.com

Meaningful advances in cancer care—immunotherapy and personalized therapy—have created great promise but also substantial challenges for patients. Research demonstrates that navigation can improve access to the cancer care system by addressing barriers, as well as facilitating quality care. The benefits of patient navigation for improving cancer patient outcomes is considerable.²

Every day, navigators are providing critical support and services to the patients most in need. However, there is still a tremendous opportunity to reach more people by increasing the number of navigators available in cancer centers and hospitals across the country. Patient navigation will continue to evolve to meet the ever-changing needs of cancer patients and their families. The overall navigation function, however, remains the same—helping improve access to timely, high-quality cancer care.

Reference jons.online.com

The aim of initiating a patient navigation program in oncology is to create a task force trained to handhold cancer patients and help them navigate through the cancer continuum of diagnosis, treatment, cure, and survival; and serve special needs of palliation, end-of-life; to offer seamless care to patients and survivors.

Patient barriers that can be broken by this system include:

• Lack of transportation.
• Lack of care for children or elderly relatives.
• Awareness of the need of attending screening programs
• Language barriers
• Mistrust of the health care system.
• Fear of finding out they have cancer or fear of the screening procedures.

It's a new profession for a healthcare professional but a lot of work needs to be done in defining the scope of such professionals in collaborative action involved in this practice.