Evolution of a health navigator model of care within a primary care setting: a case study

Abstract

Objective. Patient navigation originated as an approach for reducing disparities in cancer care and consequent health outcomes. Over time navigator models have evolved and been used to address various health issues in differing contexts. This case study outlines the evolution, purpose and effects of a lay-led health navigator model in a deprived, sparsely populated, New Zealand rural setting, where primary care services are frequently understaffed and routinely overstretched. Methods. Routinely collected service utilisation data, survey results and health navigator interview data were utilised to illustrate the client group the service works with, why primary care refer to the service, as well as lessons learned from implementation to ongoing service provision. Results. Those referred to the navigator service generally represented the most vulnerable in the community. Survey respondents, overall, were highly satisfied with the service. Navigators identified barriers and facilitators to implementation, as well as ongoing obstacles and enablers to service provision. Conclusions. This lay-led navigator service provided support to a group of unwell individuals, with few resources and multiple barriers to negotiate, and has effectively engaged with health and social care services, while overcoming various barriers and obstacles to its establishment and ongoing operation. What is known about the topic? Patient navigation models of care were first employed in the 1990s, as a strategy to increase the uptake of cancer screening among disadvantaged women. They have since expanded across the cancer care continuum, but despite favourable findings, information regarding their potential in other settings is limited. What does this paper add? This paper provides a perspective on lay-led navigation services within a rural New Zealand primary care setting. The views of primary care professionals regarding the role and value of the service are provide, as is a summary of the key lessons learnt over the implementation, establishment and ongoing service delivery phases of the programme. What are the implications for practitioners? This case study proposes that lay-led navigation services can provide practical support to primary care; assisting it to meet the needs of patients living with multiple chronic conditions and social challenges.