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Open Access 01-12-2021 | Care | Research article

Expectations and needs of socially vulnerable patients for navigational support of primary health care services

Authors: Carine Sandrine Ngo Bikoko Piemeu, Christine Loignon, Émilie Dionne, Andrée-Anne Paré-Plante, Jeannie Haggerty, Mylaine Breton

Published in: BMC Health Services Research | Issue 1/2021

Abstract

Background

Primary healthcare is the main entry to the health care system for most of the population. In 2008, it was estimated that about 26% of the population in Quebec (Canada) did not have a regular family physician. In early 2017, about 10 years after the introduction of a centralized waiting list for patients without a family physician, Québec had 25% of its population without a family physician and nearly 33% of these or 540,000, many of whom were socially vulnerable (SV), remained registered on the list. SV patients often have more health problems. They also face access inequities or may lack the skills needed to navigate a constantly evolving and complex healthcare system. Navigation interventions show promise for improving access to primary health care for SV patients. This study aimed to describe and understand the expectations and needs of SV patients.

Methods

A descriptive qualitative study rooted in a participatory study on navigation interventions implemented in Montérégie (Quebec) addressed to SV patients. Semi-structured individual face-to-face and telephone interviews were conducted with patients recruited in three primary health care clinics, some of whom received the navigation intervention. A thematic analysis was performed using NVivo 11 software.

Results

Sixteen patients living in socially deprived contexts agreed to participate in this qualitative study. Three main expectations and needs of patients for navigation interventions were identified: communication expectations (support to understand providers and to be understood by them, discuss about medical visit, and bridge the communication cap between patients and PHC providers); relational expectations regarding emotional or psychosocial support; and pragmatic expectations (information on available resources, information about the clinic, and physical support to navigate the health care system).

Conclusions

Our study contributes to the literature by identifying expectations and needs specified to SV patients accessing primary health care services, that relate to navigation interventions. This information can be used by decision makers for navigation interventions design and inform health care organizational policies.

Statistics Canada. Access to a Regular Physician 2008 - Canadian Community Health Survey. Ottawa: Statistics Canada; 2013. https://www150.statcan.gc.ca/n1/pub/82-625-x/2010001/article/11102-eng.htm

Breton M, Wong ST, Smithman MA, Kreindler S, Jbilou J, Marshall G, et al. Centralized waiting lists for unattached patients in primary care: learning from an interventions implemented in seven Canadian provinces. Healthc Policy. 2018;13(4):65–82. https://doi.org/10.12927/hcpol.2018.25555.PubMedPubMedCentralCrossRef

Breton M, Smithman MA, Brousselle A, Loignon C, Touati N, Dubois CA, et al. Assessing the performance of centralized waiting lists for patients without a regular family physician using clinical-administrative data. BMC Fam Pract. 2017;18(1):1.PubMedPubMedCentralCrossRef

Breton M, Green M, Kreindler S, Sutherland J, Jbilou J, Wong ST, et al. A comparative analysis of centralized waiting lists for patients without a primary care provider implemented in six Canadian provinces: study protocol. BMC Health Serv Res. 2017;17(1):60.PubMedPubMedCentralCrossRef

Breton M, Pineault R, Levesque JF. Reforming healthcare systems on a locally integrated basis: is there a potential for increasing collaborations in primary healthcare? BMC Health Serv Res. 2013;13(1):262. https://doi.org/10.1186/1472-6963-13-262.PubMedPubMedCentralCrossRef

BDSO. Indicators of the occupation and vitality of the territories. Proportion of the population registered with a family doctor. 2021. Available at: https://bdso.gouv.qc.ca/docs-ken/vitrine/occupation-vitaliteterritoire/documents/services_proximite_03.pdf. Accessed 18 Feb 2021.

Smithman MA, Brousselle A, Touati N. Area deprivation and attachment to a general practitioner through centralized waiting lists: a cross-sectional study in Quebec, Canada. Int J Equity Health. 2018;17(1):176. https://doi.org/10.1186/s12939-018-0887-9.PubMedPubMedCentralCrossRef

Lasser KE, Du H, Woolhandler S. Access to care, health status, and health disparities in the United States and Canada: results of a cross-national population-based survey. Am J Public Health. 2006;96(7):1300–7. https://doi.org/10.2105/AJPH.2004.059402.PubMedPubMedCentralCrossRef

Ouimet MJ, Pineault R, Prud’homme A. The impact of primary healthcare reform on equity of utilization of services in the province of Quebec: a 2003-2010 follow-up. Int J Equity Health. 2015;14(1):139. https://doi.org/10.1186/s12939-015-0243-2.PubMedPubMedCentralCrossRef

10.

Loignon C, Hudon C, Goulet É. Perceived barriers to healthcare for persons living in poverty in Quebec, Canada: the EQUIhealThY project. Int J Equity Health. 2015;14:4.PubMedPubMedCentralCrossRef

11.

Griswold KS, Homish GG, Pastore PA. A randomized trial: are care navigators effective in connecting patients to primary care after psychiatric crisis? Community Ment Health J. 2010;46(4):398–402. https://doi.org/10.1007/s10597-010-9300-x.PubMedCrossRef

12.

Carroll JK, Humiston SG, Meldrum SC. Patients’ experiences with navigation for cancer care. Patient Educ Couns. 2010;80(2):241–7. https://doi.org/10.1016/j.pec.2009.10.024.PubMedCrossRef

13.

Bishop SE, JM E, Nadkarni M. Charlottesville health access: a locality-based model of health care navigation for the homeless. J Health Care Poor Underserved. 2009;20(4):958–63. https://doi.org/10.1353/hpu.0.0219.PubMedCrossRef

14.

Ploeg J, Valaitis RK, Cleghorn L. Perceptions of older adults in Ontario, Canada on the implementation and impact of a primary care programme, health teams advancing patient experience: strengthening quality (health TAPESTRY): a descriptive qualitative study. BMJ Open. 2019;9(6):026257.CrossRef

15.

Kelly K, Doucet S, Luke A. Exploring the roles, functions, and background of patient navigators and case managers: A scoping review. Int J Nurs Stud. 2019;98:27–47.PubMedCrossRef

16.

Grimes C, Dankovchik J, Cahn M. American Indian and Alaska native cancer patients’ perceptions of a culturally specific patient navigator program. J Prim Prev. 2017;38(1–2):121–35. https://doi.org/10.1007/s10935-016-0458-z.PubMedPubMedCentralCrossRef

17.

Balaban RB, Galbraith AA, Burns ME. Patient navigator interventions to reduce hospital readmissions among high-risk safety-net patients: a randomized controlled trial. J Gen Intern Med. 2015;30(7):907–15. https://doi.org/10.1007/s11606-015-3185-x.PubMedPubMedCentralCrossRef

18.

Burns ME, Galbraith AA, Ross-Degnan D. Feasibility and evaluation of a pilot community health worker interventions to reduce hospital readmissions. Int J Qual Health Care. 2014;26(4):358–65. https://doi.org/10.1093/intqhc/mzu046.PubMedPubMedCentralCrossRef

19.

Giacomazzo A, Challacombe L. Health Navigation in HIV Services: A review of the evidence. CATIE, editor. 2018. Available at: https://www.catie.ca/en/pif/fall-2018/health-navigation-hiv-services-review-evidence.

20.

Enard KR, Ganelin DME. Reducing preventable emergency department utilization and costs by using community health workers as patient navigators. J Heal Manag. 2013;58(6):412–28.

21.

Viswanathan M, Kraschnewski JL, Nishikawa B. Outcomes and costs of community health worker interventions: a systematic review. Med Care. 2010;48(9):792–808. https://doi.org/10.1097/MLR.0b013e3181e35b51.PubMedCrossRef

22.

Rousseau SJ, Humiston SG, Yosha A. Patient navigation moderates emotion and information demands of cancer treatment: a qualitative analysis. Support Care Cancer. 2014;22(12):3143–51. https://doi.org/10.1007/s00520-014-2295-z.PubMedPubMedCentralCrossRef

23.

Reid AE, Doucet S, Luke A. Exploring the role of lay and professional patient navigators in Canada. J Health Serv Res Policy. 2020;25(4):229–37.PubMedCrossRef

24.

Wells KJ, Nuhaily S. Models of Patient Navigation. In: Calhoun E, Esparza A, editors. Patient Navigation. 1st ed. New York: Springer; 2018. p. 27–40.CrossRef

25.

IMPACT Research Program. IMPACT. 2014. Available at: https://www.impactresearchprogram.com/.

26.

Richard L, Furler J, Densley K. Equity of access to primary healthcare for vulnerable populations: the IMPACT international online survey of innovations. Int J Equity Health. 2016;15:64.PubMedPubMedCentralCrossRef

27.

Khanassov V, Pluye P, Descoteaux S. Organizational interventions improving access to community-based primary health care for vulnerable populations: a scoping review. Int J Equity Health. 2016;15(1):168. https://doi.org/10.1186/s12939-016-0459-9.PubMedPubMedCentralCrossRef

28.

Russell G, Kunin M, Harris M, Levesque JF, Descôteaux S, Scott C, et al. Improving access to primary healthcare for vulnerable populations in Australia and Canada: protocol for a mixed-method evaluation of six complex interventions. BMJ Open. 2019;9(7):e027869.

29.

Sandelowski M. Whatever happened to qualitative description? Res Nurs Health. 2000;23(4):334–40. https://doi.org/10.1002/1098-240X(200008)23:4<334::AID-NUR9>3.0.CO;2-G.PubMedCrossRef

30.

Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K. Purposeful Sampling for Qualitative Data Collection and Analysis in Mixed Method Implementation Research. Adm Policy Ment Health. 2015;42(5):533–44.PubMedPubMedCentralCrossRef

31.

Green AE, Aarons GA. A comparison of policy and direct practice stakeholder perceptions of factors affecting evidence-based practice implementation using concept mapping. Implement Sci. 2011;6(1):104. https://doi.org/10.1186/1748-5908-6-104.PubMedPubMedCentralCrossRef

32.

Grabovschi C, Loignon C, Fortin M. Mapping the concept of vulnerability related to health care disparities: a scoping review. BMC Health Serv Res. 2013;13(1):94. https://doi.org/10.1186/1472-6963-13-94.PubMedPubMedCentralCrossRef

33.

Charlebois K, Loignon C, Boudreault-Fournier A, Dupéré S, Grabovschi C. The involvement of vulnerable people in participatory research in primary care: a review of the literature. Global Health Promotion. 2014;21(3):38–45.PubMedCrossRef

34.

Bodenmann P, Wolff H, Madrid C. Vulnerabilities and health: why a new section? Swiss Med Review. 2009;5(199):849.

35.

Levesque JF, Harris MF, Russell G. Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health. 2013;12(1):18. https://doi.org/10.1186/1475-9276-12-18.PubMedPubMedCentralCrossRef

36.

Miles MB, Huberman AM, Saldaña J. Qualitative data analysis: a methods sourcebook. 3rd ed. Thousand Oaks: Sage; 2014.

37.

N.V.I.V.O. THE 11 Software for qualitative data analysis. 2015. Accessed January 2017. Available at: https://www.qsrinternational.com/nvivo-qualitative-data-analysis-software/support-services/nvivo-downloads.

38.

Peart A, Lewis V, Brown T, Russell G. Patient navigators facilitating access to primary care: a scoping review. BMJ Open. 2018;8(3):e019252. https://doi.org/10.1136/bmjopen-2017-019252.PubMedPubMedCentralCrossRef

39.

Brownstein JN, Hirsch GR, Rosenthal EL. Community health workers “101” for primary care providers and other stakeholders in health care systems. J Ambul Care Manage. 2011;34(3):210–20. https://doi.org/10.1097/JAC.0b013e31821c645d.PubMedCrossRef

40.

Krebs LU, Burhansstipanov L, Watanabe-Galloway S. Navigation as an interventions to eliminate disparities in American Indian communities. Semin Oncol Nurs. 2013;29(2):118–27. https://doi.org/10.1016/j.soncn.2013.02.007.PubMedPubMedCentralCrossRef

41.

Petereit DG, Molloy K, Reiner ML. Establishing a patient navigator program to reduce cancer disparities in the American Indian communities of Western South Dakota: initial observations and results. Cancer Control. 2008;15:254–9.PubMedCrossRef

42.

Korstjens I, Moser A. Series: practical guidance to qualitative research. Part 4: trustworthiness and publishing. Eur J Gen Pract. 2018;24(1):120–4. https://doi.org/10.1080/13814788.2017.1375092.PubMedCrossRef

43.

Morse JM. Critical analysis of strategies for determining rigor in qualitative inquiry. Qual Health Res. 2015;25(9):1212–22. https://doi.org/10.1177/1049732315588501.PubMedCrossRef

44.

Institut canadien d’information sur la santé. Learning From the Best: Benchmarking Canada's Health Care System. Ottawa: ICIS; 2011.

Title: Expectations and needs of socially vulnerable patients for navigational support of primary health care services
Authors: Carine Sandrine Ngo Bikoko Piemeu
Christine Loignon
Émilie Dionne
Andrée-Anne Paré-Plante
Jeannie Haggerty
Mylaine Breton
Publication date: 01-12-2021
Publisher: BioMed Central
Keyword: Care
Published in: BMC Health Services Research / Issue 1/2021
Electronic ISSN: 1472-6963
DOI: https://doi.org/10.1186/s12913-021-06811-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Expectations and needs of socially vulnerable patients for navigational support of primary health care services

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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