Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2023

Open Access 01-12-2023 | Care | Research

Effectiveness of system navigation programs linking primary care with community-based health and social services: a systematic review

Authors: Kylie Teggart, Sarah E. Neil-Sztramko, Abbira Nadarajah, Amy Wang, Caroline Moore, Nancy Carter, Janet Adams, Kamal Jain, Penelope Petrie, Aref Alshaikhahmed, Shreya Yugendranag, Rebecca Ganann

Published in: BMC Health Services Research | Issue 1/2023

Login to get access

Abstract

Background

Fragmented delivery of health and social services can impact access to high-quality, person-centred care. The goal of system navigation is to reduce barriers to healthcare access and improve the quality of care. However, the effectiveness of system navigation remains largely unknown. This systematic review aims to identify the effectiveness of system navigation programs linking primary care with community-based health and social services to improve patient, caregiver, and health system outcomes.

Methods

Building on a previous scoping review, PsychInfo, EMBASE, CINAHL, MEDLINE, and Cochrane Clinical Trials Registry were searched for intervention studies published between January 2013 and August 2020. Eligible studies included system navigation or social prescription programs for adults, based in primary care settings. Two independent reviewers completed study selection, critical appraisal, and data extraction.

Results

Twenty-one studies were included; studies had generally low to moderate risk of bias. System navigation models were lay person-led (n = 10), health professional-led (n = 4), team-based (n = 6), or self-navigation with lay support as needed (n = 1). Evidence from three studies (low risk of bias) suggests that team-based system navigation may result in slightly more appropriate health service utilization compared to baseline or usual care. Evidence from four studies (moderate risk of bias) suggests that either lay person-led or health professional-led system navigation models may improve patient experiences with quality of care compared to usual care. It is unclear whether system navigation models may improve patient-related outcomes (e.g., health-related quality of life, health behaviours). The evidence is very uncertain about the effect of system navigation programs on caregiver, cost-related, or social care outcomes.

Conclusions

There is variation in findings across system navigation models linking primary care with community-based health and social services. Team-based system navigation may result in slight improvements in health service utilization. Further research is needed to determine the effects on caregiver and cost-related outcomes.
Appendix
Available only for authorised users
Literature
1.
Funk LM. Relieving the burden of navigating health and social services for older adults and caregivers. Montreal: Institute for Research on Public Policy; 2019.
2.
Ploeg J, Matthew-Maich N, Fraser K, Dufour S, McAiney C, Kaasalainen S, et al. Managing multiple chronic conditions in the community: a Canadian qualitative study of the experiences of older adults, family caregivers and healthcare providers. BMC Geriatr. 2017;17(1):40.PubMedPubMedCentralCrossRef
3.
Valaitis, Cleghorn L, Ploeg J, Risdon C, Mangin D, Dolovich L, et al. Disconnected relationships between primary care and community-based health and social services and system navigation for older adults: a qualitative descriptive study. BMC Fam Pract. 2020;21(1):69.
4.
Funk LM, Dansereau L, Novek S. Carers as system navigators: exploring sources, processes and outcomes of structural burden. Gerontologist. 2019;59(3):426–35.PubMedCrossRef
5.
Bookman A, Harrington M. Family caregivers: a shadow workforce in the geriatric health care system? J Health Polit Policy Law. 2007;32(6):1005–41.PubMedCrossRef
6.
The Academy of Medical Sciences. Multimorbidity: a priority for global health research. 2018.
7.
Evans MK. Health equity — are we finally on the edge of a new frontier? N Engl J Med. 2020;383(11):997–9.PubMedCrossRef
8.
Nutbeam D, Lloyd JE. Understanding and responding to health literacy as a social determinant of health. Annu Rev Public Health. 2021;42:159–73.PubMedCrossRef
9.
Mulligan K, Hsiung S, Bhatti S, Rehel J, Rayner J. Rx: Community - Social prescribing in Ontario, Final Report. Toronto: Alliance for Healthier Communities; 2020.
10.
Alderwick HAJ, Gottlieb LM, Fichtenberg CM, Adler NE. Social Prescribing in the U.S. and England: Emerging Interventions to Address Patients' Social Needs. Am J Prev Med. 2018;54(5):715–8.
11.
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
12.
Freeman HP. The origin, evolution, and principles of patient navigation. Cancer Epidemiol Biomarkers Prev. 2012;21(10):1614–7.PubMedCrossRef
13.
McBrien KA, Ivers N, Barnieh L, Bailey JJ, Lorenzetti DL, Nicholas D, et al. Patient navigators for people with chronic disease: a systematic review. PLoS One. 2018;13(2).PubMedPubMedCentralCrossRef
14.
Mizuno Y, Higa DH, Leighton CA, Roland KB, Deluca JB, Koenig LJ. Is HIV patient navigation associated with HIV care continuum outcomes? AIDS. 2018;32(17):2557–71.PubMedCrossRef
15.
Anderson JE, Larke SC. The Sooke Navigator project: using community resources and research to improve local service for mental health and addictions. Ment Health Fam Med. 2009;6(1):21–8.PubMedPubMedCentral
16.
Corrigan PW, Pickett S, Batia K, Michaels PJ. Peer navigators and integrated care to address ethnic health disparities of people with serious mental illness. Soc Work Public Health. 2014;29(6):581–93.PubMedPubMedCentralCrossRef
17.
Carter N, Valaitis RK, Lam A, Feather J, Nicholl J, Cleghorn L. Navigation delivery models and roles of navigators in primary care: a scoping literature review. BMC Health Serv Res. 2018;18(1):96.PubMedPubMedCentralCrossRef
18.
Louart S, Bonnet E, Ridde V. Is patient navigation a solution to the problem of “leaving no one behind”? A scoping review of evidence from low-income countries. Health Policy Plan. 2021;36(1):101–16.PubMedCrossRef
19.
Tierney S, Wong G, Roberts N, Boylan AM, Park S, Abrams R, et al. Supporting social prescribing in primary care by linking people to local assets: a realist review. BMC Med. 2020;18(1):49.PubMedPubMedCentralCrossRef
20.
21.
Valaitis RK, Carter N, Lam A, Nicholl J, Feather J, Cleghorn L. Implementation and maintenance of patient navigation programs linking primary care with community-based health and social services: a scoping literature review. BMC Health Serv Res. 2017;17(1):116.PubMedPubMedCentralCrossRef
22.
23.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:1–9.
24.
25.
26.
Kreuter MW, Thompson T, McQueen A, Garg R. Addressing social needs in health care settings: evidence, challenges, and opportunities for public health. In: Fielding JE, editor. Annual Review of Public Health, Vol 42, 2021. Annual Review of Public Health. 422021. p. 329–44.
27.
Kelly KJ, 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
28.
29.
Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ. 2014;348: g1687.PubMedCrossRef
30.
31.
Ganann R, Neil-Sztramko S, Alvarez E, Kuspinar A, Kennedy C, Moore C, et al. The EMBOLDEN study: Using intervention co-design to enhance physical and community mobility in older adults. Int J Integr Care. 2022;22(S2):66.CrossRef
32.
Boult C, Leff B, Boyd CM, Wolff JL, Marsteller JA, Frick KD, et al. A matched-pair cluster-randomized trial of guided care for high-risk older patients. J Gen Intern Med. 2013;28(5):612–21.PubMedPubMedCentralCrossRef
33.
Dolovich L, Oliver D, Lamarche L, Agarwal G, Carr T, Chan D, et al. A protocol for a pragmatic randomized controlled trial using the Health Teams Advancing Patient Experience: Strengthening Quality (Health TAPESTRY) platform approach to promote person-focused primary healthcare for older adults. Implement Sci. 2016;11(101258411):49.PubMedPubMedCentral
34.
Kangovi S, Mitra N, Norton L, Harte R, Zhao X, Carter T, et al. Effect of community health worker support on clinical outcomes of low-income patients across primary care facilities: a randomized clinical trial. JAMA Intern Med. 2018;178(12):1635–43.PubMedPubMedCentralCrossRef
35.
Kangovi S, Mitra N, Smith RA, Kulkarni R, Turr LN, Huo H, et al. Decision-making and goal-setting in a randomized controlled trial of patient-centered support for chronic disease management. J Gen Intern Med. 2016;31(2 SUPPL. 1):S173–4.
36.
Mercer SW, Fitzpatrick B, Grant L, Chng NR, McConnachie A, Bakhshi A, et al. Effectiveness of community-links practitioners in areas of high socioeconomic deprivation. Ann Fam Med. 2019;17(6):518–25.PubMedPubMedCentralCrossRef
37.
Spoorenberg SLW, Wynia K, Uittenbroek RJ, Kremer HPH, Reijneveld SA. Effects of a population-based, person-centred and integrated care service on health, wellbeing and self-management of community-living older adults: a randomised controlled trial on Embrace. PLoS One. 2018;13(1).PubMedPubMedCentralCrossRef
38.
Taube E, Kristensson J, Midlov P, Jakobsson U. The use of case management for community-dwelling older people: the effects on loneliness, symptoms of depression and life satisfaction in a randomised controlled trial. Scand J Caring Sci. 2018;32(2):889–901.PubMedCrossRef
39.
Zhang M, Chao J, Li D, Gu J, Chen W, Xu H, et al. The effect of older-person centered and integrated health management model on multiple lifestyle behaviors: A randomized controlled trial from China. Arch Gerontol Geriatr. 2018;79:45–51.PubMedCrossRef
40.
Burger S. Using health coaches to help patients manage chronic disease. Nurse Pract. 2019;44(9):48–55.PubMedCrossRef
41.
Kellezi B, Wakefield JRH, Stevenson C, McNamara N, Mair E, Bowe M, et al. The social cure of social prescribing: a mixed-methods study on the benefits of social connectedness on quality and effectiveness of care provision. BMJ Open. 2019;9(11): e033137.PubMedPubMedCentralCrossRef
42.
Loftus AM, McCauley F, McCarron MO. Impact of social prescribing on general practice workload and polypharmacy. Public Health. 2017;148(0376507):96–101.PubMedCrossRef
43.
Loskutova NY, Tsai AG, Fisher EB, LaCruz DM, Cherrington AL, Harrington TM, et al. Patient navigators connecting patients to community resources to improve diabetes outcomes. J Am Board Fam Med. 2016;29(1):78–89.PubMedCrossRef
44.
Mayhew L. On the effectiveness of care co-ordination services aimed at preventing hospital admissions and emergency attendances. Health Care Manag Sci. 2009;12(3):269–84.PubMedCrossRef
45.
Pescheny JV, Gunn LH, Randhawa G, Pappas Y. The impact of the Luton social prescribing programme on energy expenditure: a quantitative before-and-after study. BMJ Open. 2019;9(6): e026862.PubMedPubMedCentralCrossRef
46.
Woodall J, Trigwell J, Bunyan AM, Raine G, Eaton V, Davis J, et al. Understanding the effectiveness and mechanisms of a social prescribing service: a mixed method analysis. BMC Health Serv Res. 2018;18(1):604.PubMedPubMedCentralCrossRef
47.
Carnes D, Sohanpal R, Frostick C, Hull S, Mathur R, Netuveli G, et al. The impact of a social prescribing service on patients in primary care: a mixed methods evaluation. BMC Health Serv Res. 2017;17(1):835.PubMedPubMedCentralCrossRef
48.
Dye C, Willoughby D, Aybar-Damali B, Grady C, Oran R, Knudson A. Improving chronic disease self-management by Older Home Health Patients through Community Health Coaching. Int J Environ Res Public Health. 2018;15(4).
49.
Franse CB, van Grieken A, Alhambra-Borrás T, Valía-Cotanda E, van Staveren R, Rentoumis T, et al. The effectiveness of a coordinated preventive care approach for healthy ageing (UHCE) among older persons in five European cities: a pre-post controlled trial. Int J Nurs Stud. 2018;88:153–62.PubMedCrossRef
50.
Tung EL, Abramsohn EM, Boyd K, Makelarski JA, Beiser DG, Chou C, et al. Impact of a low-intensity resource referral intervention on patients’ knowledge, beliefs, and use of community resources: results from the CommunityRx trial. J Gen Intern Med. 2020;35(3):815–23.PubMedCrossRef
51.
Vanderboom CE, Holland DE, Lohse CM, Targonski PV, Madigan EA. Enhancing patient-centered care: pilot study results of a community care team intervention. West J Nurs Res. 2014;36(1):47–65.PubMedCrossRef
52.
Wang ML, Gallivan L, Lemon SC, Borg A, Ramirez J, Figueroa B, et al. Navigating to health: evaluation of a community health center patient navigation program. Prev Med Rep. 2015;2:664–8.PubMedPubMedCentralCrossRef
53.
Boult C, Reider L, Frey K, Leff B, Boyd CM, Wolff JL, et al. Early effects of “Guided Care” on the quality of health care for multimorbid older persons: a cluster-randomized controlled trial. J Gerontol A Biol Sci Med Sci. 2008;63(3):321–7.PubMedCrossRef
54.
Wolff JL, Rand-Giovannetti E, Palmer S, Wegener S, Reider L, Frey K, et al. Caregiving and chronic care: the guided care program for families and friends. J Gerontol A Biol Sci Med Sci. 2009;64(7):785–91.PubMedCrossRef
55.
Dolovich L, Oliver D, Lamarche L, Thabane L, Valaitis R, Agarwal G, et al. Combining volunteers and primary care teamwork to support health goals and needs of older adults: a pragmatic randomized controlled trial. CMAJ. 2019;191(18):E491–500.PubMedPubMedCentralCrossRef
56.
Kangovi S, Mitra N, Grande D, Huo H, Smith RA, Long JA. Community health worker support for disadvantaged patients with multiple chronic diseases: a randomized clinical trial. Am J Public Health. 2017;107(10):1660–7.PubMedPubMedCentralCrossRef
57.
Pescheny JV, Gunn LH, Pappas Y, Randhawa G. The impact of the Luton social prescribing programme on mental well-being: a quantitative before-and-after study. J Public Health (Oxf). 2019(101188638).
58.
Lindau ST, Makelarski JA, Abramsohn EM, Beiser DG, Boyd K, Chou C, et al. CommunityRx: A real-world controlled clinical trial of a scalable, low-intensity community resource referral intervention. Am J Public Health. 2019;109(4):600–6.PubMedPubMedCentralCrossRef
59.
Vanderboom CE, Holland DE, Targonski PV, Madigan E. Developing a community care team: lessons learned from the community connections program, a health care home-community care team partnership. Care Manag J. 2013;14(3):150–7.PubMedCrossRef
60.
Bhatti S, Rayner J, Pinto AD, Mulligan K, Cole DC. Using self-determination theory to understand the social prescribing process: a qualitative study. BJGP Open. 2021;5(2).
61.
Bickerdike L, Booth A, Wilson PM, Farley K, Wright K. Social prescribing: less rhetoric and more reality. A systematic review of the evidence. BMJ Open. 2017;7(4):e013384.
62.
Pescheny JV, Randhawa G, Pappas Y. The impact of social prescribing services on service users: a systematic review of the evidence. Eur J Public Health. 2020;30(4):664–73.PubMedCrossRef
63.
Lukewich J, Martin-Misener R, Norful AA, Poitras ME, Bryant-Lukosius D, Asghari S, et al. Effectiveness of registered nurses on patient outcomes in primary care: a systematic review. BMC Health Serv Res. 2022;22(1):740.PubMedPubMedCentralCrossRef
64.
Das LT, Kaushal R, Garrison K, Carrillo V, Grinspan Z, Theis R, et al. Drivers of preventable high health care utilization: a qualitative study of patient, physician and health system leader perspectives. J Health Serv Res Policy. 2020;25(4):220–8.PubMedCrossRef
65.
Berkman ND CE, Seibert J, Ali R, Porterfield D, Jiang L, Wines R, Rains C, Viswanathan M. Management of high-need, high-cost patients: a “Best Fit” framework synthesis, realist review, and systematic review. Comparative Effectiveness Review No. 246. Agency for Healthcare Research and Quality; 2021.
66.
Vidovic D, Reinhardt GY, Hammerton C. Can social prescribing foster individual and community well-being? A systematic review of the evidence. Int J Environ Res Public Health. 2021;18(10):5276.
67.
Bloom I, Welch L, Vassilev I, Rogers A, Jameson K, Cooper C, et al. Findings from an exploration of a social network intervention to promote diet quality and health behaviours in older adults with COPD: a feasibility study. Pilot Feasibility Stud. 2020;6:15.PubMedPubMedCentralCrossRef
68.
Jefferson L, Golder S, Heathcote C, Avila AC, Dale V, Essex H, et al. GP wellbeing during the COVID-19 pandemic: a systematic review. Br J Gen Pract. 2022;72(718):E325–33.PubMedCrossRef
69.
70.
Jones CW. Primary care backlog will add to urgent care pressures over time. BMJ. 2021;374.
71.
Lu J, Wang Y, Hou L, Zuo Z, Zhang N, Wei A. Multimorbidity patterns in old adults and their associated multi-layered factors: a cross-sectional study. BMC Geriatr. 2021;21(1):372.PubMedPubMedCentralCrossRef
72.
Wong SYS, Zhang DX, Sit RWS, Yip BHK, Chung RYN, Wong CKM, et al. Impact of COVID-19 on loneliness, mental health, and health service utilisation: a prospective cohort study of older adults with multimorbidity in primary care. Br J Gen Pract. 2020;70(700):E817–24.PubMedPubMedCentralCrossRef
73.
World Health Organization. People-centred and integrated health services: an overview of the evidence. 2015.
74.
Lewis L, Ehrenberg N. Realising the true value of integrated care: Beyond COVID-19. International Foundation for Integrated Care; 2020.
75.
76.
Nundy S, Cooper LA, Mate KS. The quintuple aim for health care improvement: a new imperative to advance health equity. JAMA. 2022;327(6):521–2.PubMedCrossRef
Metadata
Title
Effectiveness of system navigation programs linking primary care with community-based health and social services: a systematic review
Authors
Kylie Teggart
Sarah E. Neil-Sztramko
Abbira Nadarajah
Amy Wang
Caroline Moore
Nancy Carter
Janet Adams
Kamal Jain
Penelope Petrie
Aref Alshaikhahmed
Shreya Yugendranag
Rebecca Ganann
Publication date
01-12-2023
Publisher
BioMed Central
Keyword
Care
Published in
BMC Health Services Research / Issue 1/2023
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-023-09424-5

Other articles of this Issue 1/2023

BMC Health Services Research 1/2023 Go to the issue

Research

Association of the affordable care act with racial and ethnic disparities in uninsured emergency department utilization

Research

The development of the Dutch “National model integrated care for childhood overweight and obesity”

Correction

Correction: Impact of Watson’s human caring-based health promotion program on caregivers of individuals with schizophrenia

Research

Hospital spending and length of stay attributable to perioperative adverse events for inpatient hip, knee, and spine surgery: a retrospective cohort study

Research

How older adults recovering from substance use problems experience mattering

Research

“Prescribing for the whole person”: A qualitative study exploring prescribing pharmacist views on type 2 diabetes management in New Zealand