Sarango Mariana, de Groot Alexander, Hirschi Melissa, Umeh Chukwuemeka Anthony, Rajabiun Serena
Center for Advancing Health Policy and Practice, Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts.
J Public Health Manag Pract. 2017 May/Jun;23(3):276-282. doi: 10.1097/PHH.0000000000000512.
People living with human immunodeficiency virus (HIV) (PLWH) who are most at risk for falling out of HIV primary care and detectable viral loads include homeless and unstably housed individuals and those codiagnosed with behavioral health disorders. The patient-centered medical home (PCMH) is a model that promotes provision of comprehensive, patient-centered, accessible, coordinated, and quality care for patients. This initiative provided patient navigation to HIV-positive homeless and unstably housed individuals codiagnosed with a mental health or substance use disorder as a means to create an adapted PCMH to meet the specific needs of this population.
The purpose of this analysis was to characterize the roles and responsibilities of patient navigators as part of an effort to create a medical home for homeless and unstably housed PLWH with behavioral health comorbidities.
Eighty-one in-depth interviews with clinic staff and 2 focus groups with patient navigators were conducted. Content analysis was performed to identify key roles and responsibilities of the patient navigators.
Patient navigators played an important role in creating a PCMH by working with clients to schedule and complete appointments, develop comprehensive care plans, forging critical relationships with providers both within and outside of health care systems, providing holistic support to increase patient self-management, and assisting in achieving housing stability.
It may be necessary to adapt the traditional PCMH model to effectively meet the social, behavior health, and medical needs of homeless and unstably housed PLWH with behavioral health comorbidities. A patient navigator who can invest time in supporting and connecting these patients to needed services may be a key component in creating an effective PCMH for this population. These findings highlight the roles and tasks of patient navigators that may contribute to developing a PCMH specific to homeless and unstably housed PLWH with mental health and substance use comorbidities. Implementation of such a model has the potential to improve health outcomes (such as retention in care and viral suppression) for particularly vulnerable PLWH and thereby reduce the burden of HIV infection.
最有可能脱离艾滋病毒初级护理且病毒载量无法检测的艾滋病毒感染者包括无家可归者、住房不稳定者以及同时被诊断患有行为健康障碍的人。以患者为中心的医疗之家（PCMH）是一种为患者提供全面、以患者为中心、可及、协调且高质量护理的模式。该倡议为同时被诊断患有精神健康或物质使用障碍的艾滋病毒阳性无家可归者和住房不稳定者提供患者导航服务，以此创建一个经过调整的PCMH，以满足这一人群的特殊需求。
本分析的目的是描述患者导航员的角色和职责，这是为患有行为健康合并症的无家可归和住房不稳定的艾滋病毒感染者创建医疗之家工作的一部分。
对诊所工作人员进行了81次深入访谈，并与患者导航员进行了2次焦点小组讨论。进行内容分析以确定患者导航员的关键角色和职责。
患者导航员通过与客户合作安排和完成预约、制定全面的护理计划、与医疗保健系统内外的提供者建立关键关系、提供整体支持以提高患者自我管理能力以及协助实现住房稳定，在创建PCMH方面发挥了重要作用。
可能有必要调整传统的PCMH模式，以有效满足患有行为健康合并症的无家可归和住房不稳定的艾滋病毒感染者的社会、行为健康和医疗需求。能够投入时间支持这些患者并将他们与所需服务联系起来的患者导航员可能是为这一人群创建有效PCMH的关键组成部分。这些发现突出了患者导航员的角色和任务，可能有助于为患有精神健康和物质使用合并症的无家可归和住房不稳定的艾滋病毒感染者开发特定的PCMH。实施这样的模式有可能改善特别脆弱的艾滋病毒感染者的健康结果（如保持护理和病毒抑制），从而减轻艾滋病毒感染的负担。
