Adaptations to a patient navigation program for follow‐up colonoscopy in rural primary care practices

Author:

Thompson Jamie H.1,Rivelli Jennifer S.1,Schneider Jennifer L.1,Kenzie Erin S.23,Myers Emily2,Coury Jennifer2,Davis Melinda234,Gautom Priyanka13,Coronado Gloria D.156

Affiliation:

1. Science Programs Department Kaiser Permanente Center for Health Research Portland Oregon USA

2. Oregon Rural Practice‐based Research Network Oregon Health & Science University Portland Oregon USA

3. OHSU‐PSU School of Public Health Division Oregon Health & Science University Portland Oregon USA

4. Department of Family Medicine Oregon Health & Science University Portland Oregon USA

5. Department of Population Sciences University of Arizona Cancer Center Tucson Arizona USA

6. Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health University of Arizona Tucson Arizona USA

Abstract

AbstractPurposePatient navigation is a recommended practice to improve cancer screenings among underserved populations including those residing in rural areas with care access barriers. We report on patient navigation programme adaptations to increase follow‐up colonoscopy rates after abnormal fecal testing in rural primary care practices.MethodsParticipating clinics delivered a patient navigation programme to eligible patients from 28 affiliated clinics serving rural communities in Oregon clustered within 3 Medicaid health plans. Patient navigation adaptations were tracked using data sources including patient navigation training programme reflections, qualitative interviews, clinic meetings, and periodic reflections with practice facilitators.FindingsInitial, planned (proactive) adaptations were made to address the rural context; later, unplanned (reactive) adaptations were implemented to address the impact of the COVID‐19 global pandemic. Initial planned adaptations to the patient navigation programme were made before the main trial to address the needs of the rural context, including provider shortages and geographic dispersion limiting both patient access to care and training opportunities for providers. Later unplanned adaptations were made primarily in response to COVID‐19 care suspension and staff redeployments and shortages that occurred during implementation.ConclusionWhile unplanned adaptations were implemented to address the contextual impact of the COVID‐19 pandemic on care access patterns and staffing, the changes to training content and context were beneficial to the rural setting overall and should be sustained. Our findings can guide future efforts to optimise the success of such programmes in other rural settings and highlight the important role of adaptations in implementation projects.

Funder

National Cancer Institute

Publisher

Wiley

Reference26 articles.

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3. CPSTF Recommends Patient Navigation Services to Increase Cancer Screening and Advance Health Equity. The Community Guide. Accessed April 4 2023.https://www.thecommunityguide.org/news/cpstf-recommends-patient-navigation-services-increase-cancer-screening-advance-health-equity.html

4. Patient Navigation for Colonoscopy Completion: Results of an RCT

5. Effect of patient navigation on colorectal cancer screening in a community-based randomized controlled trial of urban African American adults

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