How can vulnerable elderly patients be helped to navigate the fragmented health system?
In its latest Croakey update, the Primary Health Care Research and Information Service (better known as PHC RIS) reports there is encouraging evidence to suggest that professional health system “navigators” might be able to help elderly people with chronic health problems to remain in their homes.
It would be interesting to know whether many elderly patients have access to such help, and to know more about how widely Australian health services employ such roles.
Helping the elderly navigate the health system
Petra Bywood writes:
Most people, at some time in their lives, will require the services of multiple healthcare providers, whether it is for an unexpected accident, acute illness, chronic condition, or for comorbidities that cross healthcare sectors.
Irrespective of the underlying condition, the transitions between healthcare services or providers are critical points at which care may become fragmented, potentially leading to delays, duplications and adverse outcomes for the patient. While negotiating transitions across care sectors may be frustrating and confusing for most patients, these challenges are exacerbated for elderly chronically ill patients and their caregivers.
Many strategies have been implemented at the organisational level to improve access to care and quality of care for the elderly as they navigate the health care system. One such strategy involves employing designated healthcare workers as patient, or system, navigators to “facilitate safe and effective transitions across healthcare settings”.
While the navigator role is not new to healthcare, there is little consensus on the characteristics of a successful navigator, and few studies have documented or evaluated the impact on patient outcomes.
This systematic review examined the potential impact of different system navigation models relevant to chronic disease management in older adults. The studies used different titles, including Advanced Practice Nurse, Care Coordinator, Guided Care Nurse, Transition Coach and Case Manager to describe the navigator.
Despite differences in the population needs, the common role of the navigator was to “advocate for the patient and broker access to appropriate care as they transitioned across settings or providers”. Navigators were supported by clinical mentors and/or a multidisciplinary team.
Nine different navigator models, which were evaluated in randomised controlled trials, showed mixed effects: five reported better economic efficiency; two reported higher levels of patient and provider satisfaction with care; and five reported better patient quality of life or functionality.
Since most elderly people prefer to stay in their own homes despite deteriorating health, the health system navigator role is a promising strategy for balancing both the medical needs and preferences of this vulnerable population.
The central value of the role lies in its mission to address the barriers to accessing appropriate care and preventing chronically ill elderly patients from escalating to higher levels of care.
Further research is needed to identify the key characteristics of a good navigator for optimal patient experience, as well as assessing the effectiveness and cost-effectiveness of implementing the different navigation models.
• Petra Bywood is Research Manager, Primary Health Care Research & Information Service (PHC RIS)
Manderson, B., Mcmurray, J., Piraino, E. and Stolee, P. (2012). Navigation roles support chronically ill older adults through healthcare transitions: a systematic review of the literature. Health and Social Care in the Community, 20(2): 113-127.
This article, which can be accessed at http://dx.doi.org/10.1111/j.1365-2524.2011.01032.x features in the 16 February 2012 edition of PHC RIS eBulletin, available at http://www.phcris.org.au/publications/ebulletin/index.php.
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Previous PHC RIS columns at Croakey: