Patient Navigator Outreach and Chronic Disease Prevention Act 2005 - Assignment Example

Running Head: An Analysis of the Patient Navigator Outreach and Chronic Disease Prevention Act 2005. Introduction. Many a times, those populations and individuals with the greatest need for healthcare services lack the capacity to understand access and make benefit of the healthcare systems. Contributing factors include illiteracy, limited proficiency of English language, poverty and limited knowledge of patients’ cultures and believes by healthcare practitioners. These factors serve to exacerbate the gap healthcare providers and their consumers on the other end. They make it hard for service providers in healthcare to assist patients know the best way of participating in own healthcare. Patient navigators and navigator programs therefore became necessary in terms of providing the much needed connection between patient populations and providers with an aim of improving healthcare outcomes. Patient navigator and outreach services dates back to the year 1971 when then US President Richard Nixon ratified the National Cancer Act. Since then there have been significant improvements in healthcare outcomes in terms of reducing cancer related mortality. This can be attributed to better measures at preventing, screening and diagnosing cancer as well as the use of better treatments for the same. However, poor persons, those without any medical insurance and those without sufficient insurances covers have continued to show low 5-year survival and high rates of mortality. Disconnects still exist between discovery and delivery enterprises and also between what is known and what is applied to all people. Disparities arise when medical interventions meant for all are not equally distributed. Disparities are also occasioned by a combination of economic, cultural and social issues (Freeman and Rodriguez, 2011). Poverty is a very important cause of healthcare disparities when it comes to the management of cancer and other chronic illnesses. Poverty is a complex problem associated with other issues such as lower levels of educational achievement, squalid living conditions, total lack or insufficient social assistance, lack of employment, risky lifestyles and reduced healthcare service access. As per the 2010 national census, 14.3% of the US population representing a whooping 43.6 million persons was poor the year 2009 alone. In the same year 16.7% (50.7 million) of American citizens did not have any health insurance cover. Furthermore statistics have shown a huge gap in terms of the five year survival rates for cancers between the poor and the rich; survival is ten percent lower among the poor Americans compared to the rich. Patient Navigation. An emerging and promising strategy that will improve healthcare access and eventual outcomes in the most vulnerable groups by removing barriers to early detection management of chronic conditions such as cancer is the patient navigation & outreach services. The whole patient navigation concept was developed following the 1989 National Hearings on Cancer by the American Cancer Society among the poor. Testimonies were largely from Americans from the lower end of the social pyramid as well as the ethnic minorities diagnosed as having cancer. Going by the hearings Dr. Freeman was able to conclude that barriers to early diagnosis, treatment and prevention of cancers as well as supporting patients could be surmounted and came up with the very first navigator program at the Harlem Hospital under the auspices of the America Cancer Society. Policy makers universally supported the Patient Navigator Outreach and Chronic Disease Prevention Act 2005 (Public Law 109-18). The legislation was supported unanimously in the congress led by the senator Robert Menendez amending the Public Health Service Act to allow the Health & Human Services Secretary to make grants towards establishment of patient navigation through the year 2010. $25 million was set aside for the programs for the whole period of five years through various agencies such HRSA, NCI, Indian Health Service and Community Health Centers. The most important objective was to find whether patient navigators can actually help eliminate obstacles healthcare service access and if they can help in improving healthcare outcomes in the populations which have been historically underserved. Studies conducted recently have shown that patient navigation programs produce positive outcomes in terms increased screening rates, diagnosis and follow-up services with the ultimate result of positive healthcare outcomes. A study on screening of colorectal cancer using two patient navigators for instance reduced the rates of broken appointments from 67% down to a paltry 5% in just a month. The likelihood for patients to consistently keep appointments went upwards by approximately three times. Another study on the screening of the same cancer in a minority population setting compared two patient groups having the same demographics and having the recommendation for colonoscopy. The patient group which received navigator assistance showed a 15.8% rate of compliance whereas the group that did not have navigator services had just 5% compliance over the period of study. The group with navigator services also had a higher rate (42.1%) in terms of achievement of completion of occult blood tests as compared to 25% in other cohort that was not assisted by patient navigators. These studies found very positive results in the navigator programs. It was seen that navigators greatly helped eliminate disparities in healthcare services mainly through the facilitation of effective communication between healthcare service providers and their consumers who are patients. Navigators were also very crucial in assisting healthcare consumers overcome common barriers to healthcare access; they provided patient outreach services & disseminated educational information. They also gave assistance which was competent in terms of culture and language affiliations of patients therefore greatly enhancing the understanding between the providers and service consumers thereby improving healthcare outcomes. With patient navigator services which are sensitive to cultures and languages, yielding sustainable clinical advantages in the long term, improving compliance and health outcomes, it likely that economic benefits of healthcare systems will also go up. Through the funding of programs targeting the healthcare needs in populations which are historically underserved, the Patient Navigator Act 2005, has the great potential of significantly improving access to healthcare services, improving the efficiency of the healthcare systems and more importantly engaging patients into playing proactive as well as more informed roles in their own health(Urrea, 2009). Problem Statement 1 Can patient navigators actually help eliminate obstacles to healthcare service access and turn around the management of chronic illnesses especially among the most vulnerable populations? Problem statement 2 Can Patient Navigator Programs help in improving healthcare outcomes in the populations which have been historically underserved as well as improving the efficiency of our healthcare systems in achieving better results? Background. The “report on the Nation on Cancer in the Poor” issued by the American Cancer Society on completion of the 1989 hearings outlined most important issues with regard to cancer, chronic diseases and the poor populations in America. Critical issues were identified to revolve around poverty, social status and educational levels; the poor are faced with many obstacles to accessing healthcare services especially with cancer & other chronic conditions and will not look for service when they can’t afford. The poor suffer and endure more pain due chronic medical conditions such as cancer as compared to middle income and American rich, in most instances they go to extraordinary levels of personal sacrifice in order to afford and get care. It was also found that cancer fatalities are most prevalent in poor populations and may obstruct their access to care while at the same time educational programs on health were mostly insensitive of culture thus were significantly irrelevant. The first Patient Navigation Program in the nation was developed by Dr. Harold Freeman at New York’s Harlem Hospital. This program focused majorly on the opportunity of saving lives through elimination of obstacles to early healthcare service between the earliest point of suspicion and diagnostic detection as well as treatment of the problem. This study determined common barriers as financial e.g. lack of insurance, informational obstacles due to poor communication strategies, barriers in the medical system itself and emotional issues on the part of patients such fear and mistrust which could be culturally informed. The Patient Navigation Programs have therefore been increased to apply throughout the entire continuum health care services; they now encompass prevention of disease, early detection, medical diagnosis, management, treatment as well as survivorship to the terminal end of life. The Experience with Breast Cancer at Harlem Hospital. Prior to navigator intervention, the twenty two year period ended 1986 saw six hundred and six patient 94% of which were blacks treated for breast cancer at the Harlem Hospital Center. All these patients came from backgrounds with low financial status, and 50% of them did not have any medical insurance on their fast visit. Forty nine percent of these patients had advanced disease in the 3rd and 4th stages, just six percent visited with the disease at the first stage and the 5 year survival stood at a rate of 39%. Drastic improvement was recorded following navigator intervention which was composed of two major elements; making available free or low cost medical examinations and Patient Navigation services to make sure all patients access diagnostic & treatment services in a timely fashion. In 325 patients thus 41% were able to have early diagnosis of the disease at stages 0&1, 21% at the 3rd and 4th stages while the 5 year survival rates rose to 70%. The great improvement in results was attributable to two major factors; the provision of the free of significantly low cost examinations for breast cancer resulted into timely identification of suspicious findings, and the Patient Navigation services made possible the early diagnosis, treatment and management of disease. The Harlem patient Navigation experience was therefore crucial in informing future directions in healthcare delivery especially when considering chronic medical conditions and marginalized populations. On the principal basis of this Harlem model, therefore congress was able to pass the Patient Navigator and Chronic Disease Prevention Act which was became law in the year 2005 on President Bush’s signature. From the day this act enacted over twenty Patient Navigation Programs have received funding from the United States government through different agencies and following the achievements of these programs, the American College of Surgeons has suggested that navigation is soon going to be required as standard for approval by AcoS commission on Cancer. Principles of Patient Navigation. The concept of patient navigation was created initially as a communal intervention to address disparities in healthcare but has received great momentum which has necessitated its expansion and transformation to be recognized at the national level. Due to the great momentum, need has arose for the definition of standard principles guiding the integration of the model into the national healthcare system. The first principle is that navigation programs are patient centric and as such should facilitate the provision of healthcare focusing on patients’ movement through the usually complex continuum of healthcare in a smooth manner. The second principle is that navigation services serve to join the virtually fragmented system of healthcare to the benefit of patients. Given the fragmented manner in which care is delivered especially considering chronic patient, potential to create a smooth flow of service lies in navigation and outreach programs. Another very important function is that navigation is supposed to remove obstacles to a timely healthcare throughout the entire continuum of healthcare. It is the core purpose and reason for patient navigation and as such needs to be effectively executed preferably a patient to navigator direct relationship. A lot of need is there for the navigation of patients through disconnected healthcare systems for instance primary and tertiary healthcare points. Navigation is the best process to ensure continuity where points in the healthcare system seem to disconnect. The act was therefore necessitated by a background of great difficulties among the American poor who were enduring huge pains in terms of suffering and accessing healthcare especially for chronic diseases like cancer and others. By receiving congress support and being signed into law by the president of the time the bill expanded the concept of patient navigation to apply in the entire national healthcare system and also allowed the Health Secretary to make grants towards such programs. The act therefore presents very big opportunities in terms of bridging the gap between discovery and service delivery, improving efficiency of healthcare services through increased communication and eventually improving healthcare outcomes by removing obstacles to care as much as possible. The Landscape. Identification of Stakeholders. The patients who make up the key consumers of healthcare services constitute the most important stakeholder to the Patient Navigation Chronic diseases Act. Disparities in healthcare delivery affect patients in undesirable ways especially for those patients at the base of the social pyramid and as such the act by expanding the navigation concept to apply throughout the healthcare systems was a blessing to them. Many studies show that patients especially the poor have the greatest risk of not accessing adequate care and as such the 2005 act promised to bridge the gap and improve the situation. Also most of the barriers identified as obstructing healthcare access touch in a way or another to the patient. Poverty is one very important barrier to adequate care access among patients; many patients fail to seek medical care services just for the fact that they cannot afford to pay for the services. Many poor people therefore end up enduring and suffering a lot of pain with chronic disease with limited attention. Those who try to seek the service make extra ordinary steps in terms of personal sacrifice for their own or their families’ healthcare needs. The economic aspect is therefore a very important contributing factor to healthcare disparities that the patient navigator and chronic diseases act seeks to address. The act will make it possible for these populations to get service by bringing to their knowledge available cheap options or free services as well as important healthcare support services. Closely related to poverty is the question of educational levels; most individuals in the lower social class have lower educational attainment and therefore are affected by illiteracy issues. Due the low literacy levels patients from these populations lack important healthcare information, find it extremely difficult to navigate the seemingly complex system and therefore missing out on important care opportunities hence increase the healthcare gap between them and the rich. Patients also miss out on healthcare services due to their own cultures and language barriers as well. Fear of being associated with disease as well as mistrust among patients for healthcare providers also serve to block efforts at universal healthcare. The services of navigators as envisaged in the 2005 act therefore come in quite handy; navigators bridge the communication gap, improve understanding between patients and service providers in a culturally competent manner and avail information to patients on available cheaper options as well as free healthcare services. The second important stakeholder to this legislation involves healthcare service providers and medical practitioners; this is where interaction is recorded are an important interest group. The service providers face many challenges with patients involving consistently keeping medical appointments and seeking timely service in order to improve service delivery. Medical practitioner therefore were of the feeling that patients themselves were to be partially blamed for the poor healthcare outcomes; many of them do seek medical attention for financial and cultural reasons, others lack information necessary to inform their own health needs while others just mistrust service providers. Cultural beliefs especially in some communities as well as high illiteracy rates make it very difficult for healthcare services to be delivered in a quality way. Healthcare service providers on their parts also lack culturally competent skills that enhance communication with the local communities for the benefit of patients and the entire healthcare is stem. It was therefore the position of provider that civic education be done to sensitize Americans especially in the lower social class about available screening, diagnosis and treatment options in order to minimize obstacles and improve healthcare outcomes. Sensitize and support services therefore would be done best through patient navigators who are culturally competent, understand the communities and are able to enhance communication between the two stakeholders. The third stakeholder is the government through the various agencies related with health as well as the department of Health and Human Services. The government is responsible for the well being of its citizens and poverty, literacy levels and the ultimate disparities in health delivery are directly to be blamed on it. The government is the overall policy maker on health and any other issues that benefit its citizens. As such therefore the government was obligated to respond to the cries by other stakeholders through legislation that makes life and working easier for patients, service providers and any other interest groups easier. The Patient Navigators Outreach Act, 2005 was thus the best effort by government through its executive and legislative arms at broadening the scope of service delivery in the most sensitive way to its citizens. The patient navigation concept had given positive results in eliminating barriers to healthcare access as per the Harlem and other studies’ experience and therefore its expansion to apply through the national health continuum in a legislation was necessary. It would allow government go to the poor of poorest, as well as any other marginalized group in a manner that is culturally sensitive thus have the best chance to promote health awareness which would in turn improve outcomes when it comes to management and prevention of chronic diseases. Identification of Key Factors. The economic factor is central to effective healthcare delivery; it played its role in the background to the legislation. May patients could go without healthcare services for financial reasons while others made great personal sacrifices just to procure their own and their families’ healthcare. This is the main reason why many patients especially from poor backgrounds do not receive timely detection of diseases as well as preventive treatment and hence mortality is prevalent in the populations. Poverty is behind the observed disparities in healthcare delivery for it bars many patients from seeking service and for those who try access service, poverty is responsible for their broken medical appointment. Navigator services serve to reduce the gap between the poor and the rich in terms of health care through awareness promotion for instance on available free or cheaper options. Another important factor to consider has to do with the social status and their contribution to disparities in medical care. It is clear that the rich are able to access quality healthcare without much difficulty while those individuals living in poverty find it extremely difficult to navigate the system and obtain quality care. Prevalence of cancer and other chronic medical conditions is highest among the poor and ethnic minorities partially because of social obstacles. These populations face obstacles that range from illiteracy, lack of medical insurance covers, lack of financial ability to cater for their personal and families medical needs and also cultural beliefs which prevent them from seeking medical attention in times of sleekness. These social challenges make it very difficult for the affected populations to access quality medical care and this contributes significantly to the observed disparities. The Patient Navigation Outreach and Chronic Diseases Prevention Act therefore through funding of navigator services will go a long way in removing these barriers. Navigators will foster cultural understanding on the part of providers, avail information to patients and increase the uptake rates for services among the populations as well as improving appointment rates with eventual positive health outcomes. Implementation is another important factor to the success of this legislation in achieving universal healthcare especially when it comes to the management of chronic medical conditions. In order to achieve the main goals detecting the medical conditions in a timely manner, diagnosing early preventing and treating as well as increase medical access in marginalized populations then there must be concerted efforts at effectively implementing the act. Smooth coordination of the legislation from the Health Secretary to the administrators of health centers and down to the consumers of healthcare is very important to the successful implementation of the act. There need also to be clear definition of roles of navigators at different levels of the healthcare continuum as well as start points & endpoints of navigation services. The ultimate result of well coordinated navigation program will ensure funds are channeled to the correct targets, barriers to healthcare access are minimized, management of chronic diseases is timely initiated and better healthcare outcomes are attained. Legal factors can also not be assumed when considering the applicability of this act in the entire healthcare system. Given the nature of work taken up by navigators to promote healthcare access among those populations of people who find it to navigate the healthcare system on their own, they may be exposed to legal technicalities. As such navigation programs should be accompanied with extensive training on legal aspects of healthcare, respect for cultural diversity of Americans and observation of the code of ethics in the healthcare field. This will enable navigators avoid legal confrontations with some customers as they may be required sometimes to be in contact with patients’ health records. Also having cultural competence will enable the navigators resonate well with the patients from all cultures and walks of life while providing the effective link between them the service providers. Options. The government has the option of implementing the programs in phases with several demonstration and study sites in place and eventually role out the throughout the countries healthcare facilities. This will provide an opportunity to assess the developments in a progressive manner while at the same time perfecting the implementation. So far study findings from existing demonstration sites have shown tremendous positive outcomes of patient navigation in terms of improving healthcare delivery to Americans. In fact some agencies such as AcoS have hinted at navigation becoming a standard requirement for approval by the cancer center. The government can also opt to implement the act aggressively across the healthcare system for the five year period in a manner that ensures maximum results are realized and then the programs are dropped while the findings are used to inform service delivery going forward. This option would be marred with a myriad of challenges owing to the wide scope and need for the services of navigation in the vast American territories. Again going by the results of past studies and experiences it may not viable to abandon the services of navigators give the essential role they playing in connecting patients and providers. Recommendations. It is my recommendation that navigation requires sophisticated coordination. The coordination can be best achieved by employing an overall navigation champion charged with the sole role of overseeing activities at the various navigation phases in the large American healthcare system. There should also be a clear distinction patient navigators working in healthcare systems from the systems of patient navigation. This will eliminate challenges such duplication of roles and enhance professionalism and accountability in the ultimate. I also recommend that the government should not only focus on the five year period but look for ways to integrate the navigation programs completely in the entire healthcare system. This will eliminate the limitation of the programs to chronic diseases and expand the same cover healthcare civic education that will promote access to healthcare throughout the population. This is because most studies have identified communication as being a major obstacle to care access among people; with cultural diversity and lack cultural competence on the part of practitioners, navigation is very crucial to effective healthcare outcomes. I also recommend owing to the complex nature of the healthcare systems that there be different levels of navigation. As such therefore the navigation to be assigned for the different levels should be determined based on qualification and the desired skills for the particular level of navigation. This is in the other words is to say the large scope of navigation may require professional navigators like qualified nurses at some levels and lay trained navigators at other levels. It should also be considered that in order to ensure efficiency of the programs, care practitioners should be expected to offer care which is in tandem with their educational qualification and work experience. Conclusions. In conclusion therefore, disparities in delivery of healthcare come up as a result of many interrelated factors playing alongside each other. Economic situations, peoples’ cultures, social injustices and poverty together play a significant role. A critical lack of connection exists between what is discovered and what is delivered to all citizens in terms of preventing, diagnosing and treating chronic illnesses such as cancer. This disconnection accounts for healthcare disparities to a large extend. Many individuals from poor backgrounds, those without insurance, and persons from different cultures are faced with real obstacles when trying to obtain healthcare services that are timely. The barriers range from financial constrains, communication problems, transport, the complexity of the medical systems and social barriers. The system of patient navigation aims at significantly eliminating these barriers in order for individuals to easily get through the healthcare system and receive timely care. Navigators can allocated to specific levels of the program such as prevention services, identification, and medical diagnosis, treating the diagnosed condition and managing survivorship to the very terminal end of life. Starting from the year 1990 when the concept of patient navigation was first developed at the Harlem hospital it has receive wide adaptation and application in different health centers throughout the united states and beyond. It is particularly worth noting that four different agencies of the US government have independently launched demonstration sites for patient navigation programs. Being an emerging course of intervention in healthcare the concept has great potentials of improving timely attainment of diagnosis and disease treatment thus impacting our lives positively more especially in the vulnerable groups. The goal for all patients to receive timely treatment, and none should be made bankrupt due to the diagnosis and subsequent costs associated with chronic conditions. References. 1. Harold P. Freeman and Rian L. Rodriguez. (2011). History and Principles of Patient Navigation. 2. Joel B. Teitelbaum and Sara E. Wilensky. (2012). The Art of Structuring and Writing a Health Policy Analysis. In Essentials of Health Policy and Law. 3. Natalia M. Urrea. (2009). The Patient Navigator Outreach and Chronic Disease Prevention Act of 2005: A Bipartisan Approach to Improving Access to Care and Addressing Health Disparities. Health Policy Newsletter; vol. 22(2). Read More