Science Programs Department, Kaiser Permanente Center for Health Research, Portland, Oregon, USA.
Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, Oregon, USA.
J Eval Clin Pract. 2024 Oct;30(7):1457-1466. doi: 10.1111/jep.14068. Epub 2024 Jun 27.
Patient navigation is a recommended practice to improve cancer screenings among underserved populations including those residing in rural areas with care access barriers. We report on patient navigation programme adaptations to increase follow-up colonoscopy rates after abnormal fecal testing in rural primary care practices.
Participating clinics delivered a patient navigation programme to eligible patients from 28 affiliated clinics serving rural communities in Oregon clustered within 3 Medicaid health plans. Patient navigation adaptations were tracked using data sources including patient navigation training programme reflections, qualitative interviews, clinic meetings, and periodic reflections with practice facilitators.
Initial, planned (proactive) adaptations were made to address the rural context; later, unplanned (reactive) adaptations were implemented to address the impact of the COVID-19 global pandemic. Initial planned adaptations to the patient navigation programme were made before the main trial to address the needs of the rural context, including provider shortages and geographic dispersion limiting both patient access to care and training opportunities for providers. Later unplanned adaptations were made primarily in response to COVID-19 care suspension and staff redeployments and shortages that occurred during implementation.
While unplanned adaptations were implemented to address the contextual impact of the COVID-19 pandemic on care access patterns and staffing, the changes to training content and context were beneficial to the rural setting overall and should be sustained. Our findings can guide future efforts to optimise the success of such programmes in other rural settings and highlight the important role of adaptations in implementation projects.
患者导航是一种推荐的做法，旨在提高服务不足人群的癌症筛查率，包括那些居住在有护理障碍的农村地区的人群。我们报告了患者导航计划的适应性调整，以提高农村初级保健实践中异常粪便检测后的结肠镜检查随访率。
参与的诊所为来自俄勒冈州 28 家附属诊所的符合条件的患者提供患者导航计划，这些诊所分布在 3 个医疗补助健康计划中， clustered within 3 Medicaid health plans. 患者导航适应性调整通过数据来源进行跟踪，包括患者导航培训计划的反思、定性访谈、诊所会议以及与实践促进者的定期反思。
最初的、计划中的（主动）适应性调整是为了应对农村背景；后来，由于 COVID-19 全球大流行的影响，实施了非计划性（被动）适应性调整。在主要试验之前，对患者导航计划进行了初步的计划适应性调整，以满足农村背景的需求，包括提供者短缺和地理分散，这限制了患者获得护理和提供者培训的机会。后来，由于在实施过程中出现了 COVID-19 护理暂停和工作人员重新部署和短缺，实施了非计划性适应性调整。
虽然为了解决 COVID-19 对护理获取模式和人员配置的影响，实施了非计划性适应性调整，但培训内容和背景的变化对农村地区总体上是有益的，应该持续下去。我们的发现可以为未来在其他农村环境中优化此类计划的成功提供指导，并强调适应性调整在实施项目中的重要作用。
