Academic journal article Australian Health Review

Evolution of a Health Navigator Model of Care within a Primary Care Setting: A Case Study

Academic journal article Australian Health Review

Evolution of a Health Navigator Model of Care within a Primary Care Setting: A Case Study

Article excerpt

Introduction

Patient navigation originated in the 1990s as an approach for reducing disparities in cancer care, specifically for those with socioeconomic disadvantage, by alleviating barriers to cancer screening, timely diagnosis and treatment.1 Over time patient navigation models have beenused to address varioushealth issues in differing contexts.2 Although there remains alack ofconsensus defining what navigation is,3 alongside confusion regarding the role of navigators compared with other healthcare providers,3 and what personnel are best suited to delivering the service (e.g. lay or professional), there is agreement that patient navigation matters.4 Large studies of the impact of patient navigation are rare. However, findings from the Patient Navigation Research Program suggest that navigation services can reduce healthcare disparities.5 Evaluations of navigation services have also shown improvement in health outcomes and reductions in missed patient appointments.4

Origins of the health navigator program on the West Coast of New Zealand

The West Coast health navigator program evolved from a 3-year pilot of cancer navigators funded by the New Zealand Ministry of Health. The pilot was one of three conducted nationwide to determineif the cancer navigation model, successful in America,3 translated to the New Zealand healthcare setting. The cancer navigation pilot was launched in 2007 and based within the West Coast Primary Health Organisation (WCPHO), being the orga- nisation responsible for delivering and coordinating essential primary healthcare services to the area. The service functioned during normal office hours and encompassed the whole West Coast region.

Selection of the navigators

Lay people were appointed as navigators to avoid removing qualified staff from a limited local pool. Along with generic employment requirements such as computer skills, the selection criteria for navigators focussed more on life experience than formal qualifications. In addition, people with experience work- ing in primary healthcare or the community, or as a caregiver with knowledge of the local community and established networks, were sought. Although a tertiary qualification in health was preferred for the role of coordinator, it was not considered essential as long as the individual had experience and knowledge of the health environment from working in either the public or non-government sector.

The West Coast

The West Coast of New Zealand's South Island is the most rural, remote and sparsely populated region of the nation, with a population of 32 900 of which 3320 are Maori.6 It is one of the country's most socioeconomically disadvantaged areas, with approximately 50% living in areas classified at the bottom of the New Zealand Deprivation Index. Consequently, the region is burdened with higher than average rates of morbidity and mor- tality, as well as lower life expectancy.7

Currently, primary care services are delivered via eight general practices and a series of rural clinics, with secondary care services delivered from a hospital in Greymouth supple- mented by an ambulatory primary care facility in Westport. Tertiary care is provided in Christchurch, a round trip of be- tween 500 and 1000 km, dependent on where the person is domiciled.

Regionally, private and publically owned general practices have difficulty recruiting and retaining health professionals, due in part to the high level of professional isolation and increased on- call pressures.8 Persistent workforce shortages, combined with a multimorbid ageing population,9 has resulted in a pressurised primary healthcare system challenged to provide continuity and coordination of care.

Revised service

All three national cancer navigation pilots underwent robust external process and impact evaluation.10 Despite the positive findings, Ministry of Health funding ceased at the end of the 3 years. The WCPHO, impressed by the pilot, decided to continue funding the service out of surplus funds. …

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