Department of Medicine (Tang); Department of Community Health Sciences (Tang, Sharma); O' Brien Institute for Public Health (Tang, Ghali); W21C Research and Innovation Centre, Cumming School of Medicine (Kelly, Sharma); Office of the Vice-President (Research) (Ghali), University of Calgary, Calgary, Alta.
CMAJ Open. 2021 Sep 7;9(3):E841-E847. doi: 10.9778/cmajo.20210004. Print 2021 Jul-Sep.
Patient navigation is a complex intervention that has garnered substantial interest and investment across Canada. We conducted an environmental scan to understand the landscape of patient navigation programs within the health care system in Alberta, Canada.
We included patient navigation programs within Alberta Health Services (AHS) and Alberta's Primary Care Networks (PCNs). Key informants were asked in October 2016 to identify existing programs and their corresponding program contacts. These program contacts were invited to complete a telephone-based survey from October 2016 to July 2017, to provide program descriptions and eligibility criteria, and to identify gaps in navigation. Programs were included if they engaged patients on an individual basis, and either facilitated continuity of care or promoted patient and family empowerment. We tabulated results and calculated summary statistics for program characteristics.
Ninety-five potentially eligible programs were identified by key informants. The response rate to the study survey was 73% ( = 69). After excluding programs not meeting inclusion criteria, we included a total of 58 programs in the study: 43 AHS programs and 15 PCN programs. Nearly all programs (93%, = 54) delivered navigation via an individual acting as a navigator. A minority of programs also included nonnavigator components, such as Web-based resources (7%, = 4) and process or structural changes to facilitate navigation (22%, = 13). Certain patient subgroups were particularly well-served by patient navigation; these included patients with cancer, substance use disorders or mental health concerns, and pediatric patients. Gaps identified in navigation fell under 4 domains: awareness, resources, geographic distribution and integration.
Patient navigation programs are common and have extended beyond cancer care, from which the construct originated; however, gaps include a lack of awareness and inequitable access to the programs. These findings will be of interest to those developing and implementing patient navigation interventions in Alberta and other jurisdictions.
患者导航是一种复杂的干预措施，在加拿大得到了广泛的关注和投资。我们进行了环境扫描，以了解加拿大艾伯塔省医疗保健系统中患者导航计划的情况。
我们纳入了艾伯塔省卫生服务局（AHS）和艾伯塔省初级保健网络（PCN）内的患者导航计划。2016 年 10 月，向关键知情人询问现有的计划及其相应的计划联系人。这些计划联系人被邀请在 2016 年 10 月至 2017 年 7 月期间完成一项基于电话的调查，提供计划描述和资格标准，并确定导航中的差距。如果计划以个体为基础，促进护理连续性或促进患者和家庭赋权，则将其纳入。我们对结果进行了分类，并计算了计划特征的汇总统计数据。
关键知情人确定了 95 个潜在的合格计划。对研究调查的回复率为 73%（=69）。在排除不符合纳入标准的计划后，我们共纳入了 58 个计划：43 个 AHS 计划和 15 个 PCN 计划。几乎所有计划（93%，=54）都通过导航员提供导航服务。少数计划还包括非导航员组成部分，如基于网络的资源（7%，=4）和促进导航的流程或结构变化（22%，=13）。某些患者亚组特别受益于患者导航；这些患者包括癌症、物质使用障碍或精神健康问题患者，以及儿科患者。导航中发现的差距属于 4 个领域：意识、资源、地理分布和整合。
患者导航计划很常见，并且已经超越了癌症护理的范围，因为该方法最初就是从癌症护理中发展出来的；然而，差距包括缺乏对这些计划的认识和公平获得这些计划的机会。这些发现将引起艾伯塔省和其他司法管辖区开发和实施患者导航干预措施的人的兴趣。
