"Somebody That can Meet you on Your Level:" Cancer Survivors' Perspectives on the Role of Indigenous Patient Navigators in Cancer Care.

BACKGROUND: Cancer incidence has increased for First Nations and Métis Peoples in Canada over recent years. Despite a growing cancer burden, there remain challenges to accessing culturally appropriate and quality care in Saskatchewan. OBJECTIVE: The study aimed to explore, from cancer survivors' perspectives, the potential of Indigenous patient navigators to enhance the healthcare experiences of First Nations and Métis cancer survivors in Saskatchewan. METHODS: We conducted semi-structured interviews with 19 First Nations and Métis cancer survivors. Participants were interviewed by phone between May 2022 to March 2023. Thematic analysis was conducted to generate themes, categories, and codes reflecting participants' experiences with patient navigators. RESULTS: Participants reported several supports to help patients with cancer through their cancer journey, including family, community, traditional ways, and First Nations and Métis health support services. Challenges to accessing care included language and communication barriers, logistical challenges, cultural differences, financial challenges, and gaps in care. Indigenous patient navigators may play a critical role in overcoming barriers by providing communication, translation, coordination, education, advocacy, and guidance to Indigenous cancer survivors. In participants' view, the tasks of Indigenous patient navigators could vary, ranging from helping schedule appointments to advocating for the patient's treatment preferences. In addition, Indigenous patient navigators could be helpful bridging Western medicine with traditional medicine when supporting patients seeking cancer care. CONCLUSION: According to study participants, Indigenous patient navigators could be beneficial to Indigenous cancer survivors in Saskatchewan.

Patient navigation job roles by levels of experience: Workforce Development Task Group, National Navigation Roundtable.

PLAIN LANGUAGE SUMMARY: Cancer patient navigators work in diverse settings ranging from community-based programs to comprehensive cancer centers to improve outcomes in underserved populations by eliminating barriers to timely cancer prevention, early detection, diagnosis, treatment, and survivorship in a culturally appropriate and competent manner. This article clarifies the roles and responsibilities of Entry, Intermediate, and Advanced level cancer patient navigators. The competencies described in this article apply to patient navigators, nurse navigators, and social work navigators. This article provides a resource for administrators to create job descriptions for navigators with specific levels of expertise and for patient navigators to advance their oncology careers and attain a higher level of expertise.

Transitional Care Navigation.

OBJECTIVES: This manuscript aims to provide an extensive review of the literature, synthesize findings, and present substantial insights on the current state of transitional care navigation. Additionally, the existing models of care, pertaining to the concept and approach to transitional care navigation, will be highlighted. METHODS: An extensive search was conducted though using multiple search engines, topic-specific key terminology, eligibility of studies, as well as a limitation to only literature of existing relevance. Integrity of the evidence was established through a literature review matrix source document. A synthesis of nursing literature from organizations and professional publications was used to generate a comparison among various sources of evidence for this manuscript. Primary evidence sources consisted of peer-reviewed journals and publications from professional organizations such as the AHRQ, Academic Search Premier, CINAHL Plus with Full Text, and the Talbot research library. RESULTS: A total of five systematic reviews (four with meta-analysis) published between 2016 and 2022 and conducted in several countries (Brazil, Korea, Singapore, and the US) were included in this review. A combined total of 105 studies were included in the systematic reviews with 53 studies included in meta-analyses. The review of the systematic reviews identified three overarching themes: care coordination, care transition, and patient navigation. Care coordination was associated with an increase in care quality rating, increased the health-related quality of life in newly diagnosed patients, reduced hospitalization rates, reduced emergency department visits, timeliness in care, and increased appropriateness of healthcare utilization. Transitional care interventions resulted to reduced average number of admissions in the intervention (I) group vs control (C) (I = 0.75, C = 1.02) 180 days after a 60-day intervention, reduced readmissions at 6 months, and reduced average number of visits 180 days after 60-day intervention (I = 2.79, C = 3.60). Nurse navigators significantly improved the timeliness of care from cancer screening to first-course treatment visit (MD = 20.42, CI = 8.74 to 32.10, P = .001). CONCLUSION: The care of the cancer patient entails treatments, therapies, and follow-up care outside of the hospital setting. These transitions can be challenging as they require coordination and collaboration among various health care sites. The attributes of transitional care navigation overlap with care coordination, care transition, and patient navigation. There is an opportunity to formally develop a transitional care navigation model to effectively addresses the challenges in care transitions for patient including barriers to health professional exchange of information or communication across care settings and the complexity of coordination between care settings. The transitional care navigation and clinic model developed at a free-standing NCI-designated comprehensive cancer center is a multidisciplinary approach created to close the gaps in care from hospital to home. IMPLICATIONS FOR NURSING PRACTICE: A transitional care navigation model aims to transform the existing perspectives and viewpoints of hospital discharge and transition of care to home or post-acute care settings as two solitary processes to that of a collective approach to care. The model supports provides an integrated continuum of quality, comprehensive care that supports patient compliance with treatment regimens, reinforces patient and caregiver education, and improves health outcomes.

Person-Centered Navigator Program for People with Parkinson's Disease: A Pilot Study.

There are limited Parkinson's disease (PD)-specific navigator programs, although PD is chronic and requires life-long comprehensive care. As most patient navigation literature focuses on oncology and is based in the West, this study aimed to develop a person-centered navigator program for PD and evaluate its preliminary outcomes and feasibility in the Korean context. The program was developed using the "analysis, design, development, implementation, and evaluation" model, and "professional navigation framework." Initially, 28 participants were recruited to participate in an 8-week navigator program. The retention rate was 82%. Social function was significantly improved 12 weeks after baseline. Participants reported high satisfaction with the program, suggesting that it was well-accepted. This study systematically developed a navigator program based on PD-specific needs and the Korean context. Future models should focus on personal and participatory attributes. Navigator programs for people with PD represent appropriate and evolving healthcare interventions.

Navigating Trauma Patients and Families Through Unfamiliar Territory.

BACKGROUND: Trauma teams work diligently to manage the complex medical needs of trauma patients. In addition to medical care, there is also a need to assist patients and their families as they navigate the emotional and physical journey of trauma. The role of trauma nurse navigator was developed to address these holistic needs. OBJECTIVE: This article aims to describe the implementation of a trauma nurse navigator role. METHODS: This article describes the development and implementation of a trauma nurse navigator role at a Level II trauma center in 2018. The trauma nurse navigator serves as a patient resource and utilizes creative problem solving to optimize care. The trauma nurse navigator also serves on the multidisciplinary team, working with providers, nursing staff, rehabilitation staff, and case management to provide seamless care to trauma patients. RESULTS: Implementation of the trauma nurse navigator role was well received by patients, families, and the multidisciplinary trauma team. The trauma nurse navigator role expanded the psychosocial support of trauma patients and increased patient satisfaction. CONCLUSION: Although other specialties have seen the benefits of including a patient navigator on the team, this is a potential for trauma centers as they strive to provide high-quality patient care.

The impact of informal patient navigation initiatives on patient empowerment and National Health Insurance responsiveness in Indonesia.

BACKGROUND: Indonesia introduced a universal National Health Insurance (NHI) programme Jaminan Kesehatan Nasional (JKN) in 2014. However, challenges in timely consultation and access to health services resulted in the introduction of formal and informal patient navigation initiatives which facilitates access for patients. Informal patient navigation may emerge from the gaps in the services of the formal patient navigation. This study assesses how three informal non-government patient navigation initiatives emerged, are organised, operate and interact with JKN authorities to enhance patient empowerment and JKN responsiveness. METHODS: This was a qualitative study comprising of document review, semi-structured interviews with key stakeholders and direct observations at JKN-contracted health facilities. Data was analysed deductively and inductively using Molyneux et al's accountability assessment framework to assess context, content, and process of the informal patient navigation initiatives. RESULTS: Our study found that informal patient navigation initiatives bridge a gap left by formal navigation initiatives. The navigators help spread awareness among patients of their benefits and entitlements and assist patients to communicate with health providers and authorities. However, we find limited effects on people's ability to navigate the system themselves, on systemic change, or on JKN responsiveness. CONCLUSION: We may know that when access to health services is challenged then formal or informal patient navigation initiatives to facilitate access for patients may emerge. What this study adds is how informal patient navigation bridge a gap left by formal navigation initiatives, from how they are organized, operate and interact with the NHI authorities. We demonstrate that in the absence of well-functioning formal navigation initiatives, the informal initiatives may fill a critical gap. However, their efforts are time intensive and do not translate across the population. What is implied here is that more is required from JKN authorities to enhance interaction with informal patient navigation to advance systemic change toward equitable access to NHI.

Pairing Project ECHO and patient navigation as an innovative approach to improving the health and wellness of cancer survivors in rural settings.

PURPOSE: We conducted a 12-month pilot study of 2 complementary strategies for improving rural cancer survivorship outcomes: (1) Project ECHO, a telementoring model to increase knowledge and skills about cancer survivorship among multidisciplinary health care provider teams in rural areas and (2) patient navigation (PN) services to connect rural cancer survivors with resources for enhancing health and wellness. METHODS: We recruited 4 CDC-funded National Comprehensive Cancer Control Program sites to implement Project ECHO and PN interventions for a defined rural population in each of their jurisdictions. Sites received ongoing technical assistance and a stipend to support implementation. We conducted a mixed-methods evaluation consisting of quantitative performance monitoring data and qualitative interviews with site staff to assess implementation. FINDINGS: Site teams delivered 21 cancer survivorship ECHO sessions to rural providers resulting in 329 participant encounters. Almost all (93%) ECHO participants reported enhanced knowledge of cancer survivorship issues, and 80% reported intent to apply learnings to their practices. Site teams engaged 16 patient navigators who navigated 164 cancer survivors during the study period. Successful implementation required strong partnerships, clear avenues for recruitment of rural providers and cancer survivors, and activities tailored to local needs. Fostering ongoing relationships among sites through community of practice calls also enhanced implementation. CONCLUSIONS: Sites successfully implemented a novel approach for enhancing care for cancer survivors in rural communities. Pairing Project ECHO to address structural barriers and PN to address individual factors affecting survivorship may help bridge the health equity gap experienced by cancer survivors in rural communities.

Implementation of a Multisite Financial Reimbursement Program in Cancer Clinical Trials Integrated With Patient Navigation: A Pilot Randomized Clinical Trial.

PURPOSE: Cancer clinical trial participants face considerable indirect costs associated with participation, such as travel and lodging, which may contribute to poor enrollment. Here, we report the findings in IMproving Patient Access to Cancer clinical Trials, a pilot feasibility study investigating the efficacy of offering a financial reimbursement program (FRP) during a therapeutic clinical trial discussion with or without additional outreach in improving patient enrollment. METHODS: Study participants for this study were recruited at two National Cancer Institute-designated comprehensive cancer centers (CCCs) from April 8, 2019, to September 19, 2019. Eligible participants were adults with a cancer diagnosis being approached to consider enrollment in a clinical trial. Participants were randomly assigned 1:1 to receive no follow-up (usual care) or a follow-up telephone call to facilitate FRP utilization stratified by study site. The target enrollment was 132 patients, with 66 patients in each study arm. The primary outcome was the consent rate to the multisite interventional study on the FRP among participants enrolling in clinical trials. RESULTS: The study had a 78% consent rate and enrolled a total of 132 participants, of whom 51% were non-White compared with 28% of CCC treatment clinical trial participants in 2019. No difference in enrollment in clinical trials between the two study arms was observed as the proportion of enrollment was 70% for both study arms. The most common reason for not enrolling in a clinical trial was due to ineligibility determined through screening procedures (75%). CONCLUSION: The current study observed that implementation of FRP at CCCs is feasible and serves a diverse patient population. Future studies will measure the impact of programs on overall clinical trial accrual and among racial/ethnic minorities.

Benefícios do programa de navegação de pacientes e assistência de enfermagem em oncologia: revisão integrativa / Beneficios del programa de atención de enfermería de navegación y oncología del paciente: revisión integrativa / Benefits of the patient navigation and oncology nursing care program: integrative review

Objetivo: analisar pesquisas que adotaram como objeto os benefícios do programa navegação de pacientes e a assistência de enfermagem. Método: Trata-se de uma revisão integrativa utilizando a estratégia PICO (Paciente, Intervenção, Comparação e Desfecho). Bases de dados selecionadas: LILACS, Medline, IBECS, BDENF e SCIELO, entre 2015 e 2020. Descritores de busca: Enfermagem; Navegação de pacientes; Oncologia; Assistência. Resultados: Foram analisados 11 artigos, nos quais pode-se verificar que os benefícios relativos à inserção do programa de navegação de pacientes e da enfermagem dentro dos serviços de oncologia foram: reestruturação de ambos buscando a padronização e diretrizes; agilidade no tratamento; além do empoderamento da família/cliente no seguimento dos processos/tratamentos. Conclusões: No Brasil, há poucos estudos relacionados a implementação do programa de navegação a da assistência em enfermagem na oncologia. Porém, a literatura existente trouxe como promissores os benefícios ao cliente/família e à instituição, além da agilidade nos processos inerentes ao tratamento(AU)

Objective: to analyze research that adopted the benefits of the patient navigation program and nursing care as their object. Method: This is an integrative review using the PICO strategy (Patient, Intervention, Comparison and Outcome). Selected databases: LILACS, Medline, IBECS, BDENF and SCIELO, between 2015 and 2020. Search descriptors: Nursing; Patient navigation; Oncology; Assistance. Results: 11 articles were analyzed, in which it can be verified that the benefits related to the insertion of the navigation program for patients and nursing within the oncology services were: restructuring of both seeking standardization and guidelines; agility in treatment; in addition to the empowerment of the family/client in following the processes/treatments. Conclusions: In Brazil, there are few studies related to the implementation of the navigation program and nursing care in oncology. However, the existing literature brought as promising benefits to the client/family and the institution, in addition to the agility in the processes inherent to the treatment(AU)

Objetivo: analizar las investigaciones que adoptaron como objeto los beneficios del programa de navegación del paciente y los cuidados de enfermería. Método: Se trata de una revisión integradora que utiliza la estrategia PICO (Paciente, Intervención, Comparación y Resultado). Bases de datos seleccionadas: LILACS, Medline, IBECS, BDENF y SCIELO, entre 2015 y 2020. Descriptores de búsqueda: Enfermería; Navegación del paciente; Oncología; Asistencia. Resultados: Se analizaron 11 artículos, en los cuales se puede constatar que los beneficios relacionados con la inserción del programa de navegación para pacientes y enfermería dentro de los servicios de oncología fueron: reestructuración de ambos buscando estandarización y lineamientos; agilidad en el tratamiento; además del empoderamiento de la familia / cliente en el seguimiento de los procesos / tratamientos. Conclusiones: En Brasil, existen pocos estudios relacionados con la implementación del programa de navegación y cuidados de enfermería en oncología. Sin embargo, la literatura existente trajo como beneficios prometedores para el cliente / familia y la institución, además de la agilidad en los procesos inherentes al tratamiento.(AU)

The Role of the Indigenous Patient Navigator: A Scoping Review.

BACKGROUND: Healthcare systems are complex and as a result patients may experience fragmentation of services. Indigenous populations experience increasingly disproportionate health disparities compared to non-Indigenous populations. Patient navigation is known as a patient-centered approach to empower individuals to connect with appropriate services. Literature surrounding the Indigenous Patient Navigator (IPN) remains sparse necessitating this scoping review. Purpose: To map the current state of the role of the IPN internationally within Canada, United States, Australia and New Zealand. METHODS: Estalished methodological framework by Arksey and O'Malley and the PRISMA extension for scoping reviews was used. RESULTS: A total of 820 articles were reviewed from four databases, yielding sixteen articles. CONCLUSIONS: The absence of published literature surrounding the IPN role in Australia and New Zealand was surprising considering similar histories of colonization. The term navigator was used most often and was typically used when describing lay/peer roles. Professional roles were described using specific role descriptions. Six IPN roles were identified including: (1) social service navigation, (2) wholistic support of Indigenous people, (3) advocacy/building capacity, (4) health assessment, (5) administrative navigation, and (6) outreach. Additionally, barriers and enablers IPNs address are identified. This scoping review will assist to promote and reinforce the IPN role.

HIV Patient Navigation in the United States: A Qualitative Meta-Synthesis of Navigators' Experiences.

Patient navigation is increasingly used to link and (re)engage persons with human immunodeficiency virus (HIV) to care. A more holistic understanding of patient navigation can be achieved by exploring the experiences of navigators, the persons who comprise half of the navigation process. We conducted a meta-synthesis of navigator experiences with HIV patient navigation using a phenomenological approach. We identified nine relevant studies. Data were analyzed using thematic synthesis. Analysis identified two overarching themes relating to (1) the breadth and depth of bidirectional relationships and functional activities that navigators undertake to connect their clients to care and (2) the inherently personal experience of delivering navigation services. From these thematic findings, we recommend that HIV patient navigators exhibit capacity and expertise in developing and maintaining interpersonal relationships with clients and health care systems/providers and develop self-care practices and emotional boundaries with clients. Our review seeks to advance public health research and practice by articulating key experiences and perspectives of HIV patient navigators, drawing findings and recommendations applicable to the development, implementation, and evaluation of HIV patient navigation.

Evaluation of a Nurse-Led Patient Navigation Intervention: Follow-Up of Patients After Autologous and Allogeneic Stem Cell Transplantation.

BACKGROUND: Complex survivorship cancer care requires nurse-led interventions. Therefore, a nurse-led patient navigation intervention was developed in which trained cancer nurses gave advice and referred to other professionals during the process of recovery and rehabilitation of hematopoietic stem cell transplantation (HSCT) patients. OBJECTIVE: The aim of this study was to understand the nature and effect of this nurse-led information and referral intervention. METHODS: Of the 199 included patients in the intervention group, 75 completed the quality of life, quality of care, self-efficacy, and self-management behavior questionnaires at baseline and at 6 and 12 months after HSCT. A historical control group of 62 patients completed the same questionnaires 12 months after HSCT. In addition, patients' experiences with the intervention were evaluated in 2 focus groups. RESULTS: Patients emphasized the holistic approach of the cancer nurses and the opportunity to discuss psychosocial domains of life. Within the intervention group, a statistically significant effect on quality of life was demonstrated over time. The differences in quality of life, self-efficacy, and self-management were not significant between the intervention group and control group. CONCLUSION: The holistic focus of this nurse-led intervention proved to be acceptable to the HSCT patients and promising in supporting the (complex) challenges that these patients face during their process of recovery and rehabilitation. IMPLICATIONS FOR PRACTICE: Nurse-led patient navigation interventions with a holistic approach when included in the daily practice of complex survivorship cancer care can support HSCT patients' information and referral needs during their rehabilitation.

Precision Patient Navigation to Improve Rates of Follow-up Colonoscopy, An Individual Randomized Effectiveness Trial.

BACKGROUND: Colorectal cancer screening by annual fecal immunochemical test (FIT) with follow-up on abnormal results is a cost-effective strategy to reduce colorectal cancer incidence and mortality. Unfortunately, many patients with abnormal results do not complete a follow-up colonoscopy. We tested whether navigation targeted to patients who are unlikely to complete the procedure may improve adherence and long-term outcomes. METHODS: Study participants were patients at a large, integrated health system (Kaiser Permanente Northwest) who were ages 50 to 75 and were due for a follow-up colonoscopy after a recent abnormal FIT result. Probability of adherence to follow-up was estimated at baseline using a predictive risk model. Patients whose probability was 70% or lower were randomized to receive patient navigation or usual care, with randomization stratified by probability category (<50%, 50% < 60%, 60% < 65%, 65% ≤ 70%). We compared colonoscopy completion within 6 months between the navigation and usual care groups using Cox proportional hazards regression. RESULTS: Participants (n = 415; 200 assigned to patient navigation, 215 to usual care) had a mean age of 62 years, 54% were female, and 87% were non-Hispanic white. By 6 months, 76% of the patient navigation group had completed a colonoscopy, compared with 65% of the usual care group (HR = 1.35; 95% confidence interval, 1.07-1.72; log-rank P value = 0.027). CONCLUSIONS: In this randomized trial, patient navigation led to improvements in follow-up colonoscopy adherence. IMPACT: More research is needed to assess the value of precision-directed navigation programs.

How could patient navigation help promote health equity in sub-Saharan Africa? A qualitative study among public health experts.

The indigents have long been excluded from health policies in sub-Saharan Africa. Despite recent efforts by some countries to allow them free access to health services, they face a multitude of non-financial barriers that prevent them from accessing care. Interventions to address the multiple patient-level barriers to care, such as patient navigation interventions, could help reverse this trend. However, our scoping review showed that no navigation interventions in low-income countries targeted the indigents. The objective of this qualitative study is, therefore, to go beyond the lack of evidence and discuss relevant approaches to act in favor of health care equity. We interviewed 22 public health experts with the objective of finding out which actions related to patient navigation programs (identified in the scoping review for other target groups) could be relevant and/or adapted for the indigents. For each ability to access care described by Levesque and colleagues, we were thus able to list the potential opportunities and challenges of implementing each type of action for the indigents in sub-Saharan Africa. Overall, the experts all felt that patient navigation programs were very relevant to implement for the indigents. They emphasized the need for personalized follow-up and for holistic actions to consider the whole context of the situation of indigence. The recommendations made by the experts are valuable in guiding political decision-making, while leaving room for adaptation of the proposed guidelines according to different contexts.

Clinical outcomes of patient navigation performed by nurses in the oncology setting: an integrative review.

OBJECTIVE: to evidence the clinical outcomes of navigation performed by nurses in cancer patients. METHODS: this is an integrative literature review with collection in MEDLINE via PUBMED, LILACS, Web of Science, Scopus, and CINAHL databases. The final sample consisted of seven studies. The data were analyzed and presented descriptively. Data related to clinical outcomes were compiled and described in full. The Agency for Healthcare Research and Quality categorization was used to assess the level of evidence. RESULTS: the clinical outcomes demonstrated were decreased distress, anxiety and depression, improved control and management of symptoms, improved physical conditioning, improved quality and continuity of care, improved quality of life, reduced time to start treatment. FINAL CONSIDERATIONS: there is research that shows better clinical outcomes in cancer patients through navigation by nurses across the continuum of health care.

Examining the hurdles in defining the practice of Nurse Navigators.

BACKGROUND: Nurse navigators are an emerging workforce providing care to people with multiple chronic conditions. The role of the navigators is to identify patients requiring support in negotiating their health care. PURPOSE: A critical discourse analysis was used to examine qualitative data collected from nurse navigators and consenting navigated patients to identify key indicators of how nurse navigators do their work and where the success of their work is most evident. DISCUSSION: Nurse navigators help patients who have lost trust in the health system to re-engage with their interdisciplinary health care team. This re-engagement is the final step in a journey of addressing unmet needs, essential to hospital avoidance. CONCLUSION: Nurse navigators provide a continuum of authentic and holistic care. To acknowledge the true value of nurse navigators, their performance indicators need to embrace the value-added care they provide.

Outcomes from a pilot patient-centered hospital-to-home transition program for children hospitalized with asthma.

OBJECTIVE: To evaluate a multi-component hospital-to-home (H2H) transition program for children hospitalized with an asthma exacerbation. METHODS: A pilot prospective randomized clinical trial of guideline-based asthma care with and without a patient-centered multi-component H2H program among children enrolled in K-8th grade on Medicaid hospitalized for an asthma exacerbation. H2H program includes 5 components: medications in-hand at discharge, school-based asthma therapy (SBAT) for controller medications, referral for home trigger assessments, communication with the primary care provider (PCP), and patient navigator support. Primary outcomes included feasibility and acceptability. Secondary outcomes included healthcare utilization, asthma morbidity, and caregiver quality of life. RESULTS: A total of 32 children were enrolled and randomized. Feasibility outcomes in the intervention group included: medications in-hand at discharge (100%); SBAT for controller medication initiated (100%); home visit referrals made (100%) and home visits completed within 4 weeks of discharge (44%); PCP communication (100%); patient navigator communication at 3 days (81.3%) and 14 days (46.7%). Acceptability outcomes in the intervention group included: 87.5% of families continued SBAT, and 87.5% of families reported it was extremely helpful to have the home visit referral. Adjusting for baseline differences in age, asthma severity and control, there was no significant difference in healthcare utilization outcomes. CONCLUSION: These pilot data suggest that comprehensive care coordination initiated during the inpatient stay is feasible and acceptable. A larger trial is justified to determine if the intervention may reduce healthcare utilization for urban, minority children with asthma.

Patient navigation in epilepsy care.

The concept of patient navigation was first introduced in 1989 by the American Cancer Society and was first implemented in 1990 by Dr. Harold Freeman in Harlem, NY. The role of a patient navigator (PN) is to coordinate care between the care team, the patient, and their family while also providing social support. In the last 30 years, patient navigation in oncological care has expanded internationally and has been shown to significantly improve patient care experience, especially in the United States cancer care system. Like oncology care, patients who require epilepsy care face socioeconomic and healthcare system barriers and are at significant risk of morbidity and mortality if their care needs are not met. Although shortcomings in epilepsy care are longstanding, the COVID-19 pandemic has exacerbated these issues as both patients and providers have reported significant delays in care secondary to the pandemic. Prior to the pandemic, preliminary studies had shown the potential efficacy of patient navigation in improving epilepsy care. Considering the evidence that such programs are helpful for severely disadvantaged cancer patients and in enhancing epilepsy care, we believe that professional societies should support and encourage PN programs for coordinated and comprehensive care for patients with epilepsy.

Personalized Care Management for Persons with Parkinson's Disease.

There is a growing awareness that delivery of integrated and personalized care is necessary to meet the needs of persons living with Parkinson's disease. In other chronic diseases than Parkinson's disease, care management models have been deployed to deliver integrated and personalized care, yielding positive effects on patients' health outcomes, quality of life and health care utilization. However, care management models have been highly heterogeneous, as there is currently no clear operationalization of its core elements. In addition, most care management models are disease-specific and not tailored to the individual needs and preferences of a patient. In this viewpoint we present an integrated and personalized care management model for persons with Parkinson's disease costing of five core elements: (1) care coordination, (2) patient navigation, (3) information provision, (4) early detection of signs and symptoms through proactive monitoring and (5) process monitoring. Following the description of each core element, implications for implementing the model into practice are discussed. Finally, we provide clinical and methodological considerations on the evaluation of care management models.

Integrated Pharmacy and PrEP Navigation Services to Support PrEP Uptake: A Quality Improvement Project.

Preexposure prophylaxis (PrEP) is highly effective in preventing HIV among both men and women, with the reduction in risk directly linked to medication adherence. Navigation services and other adherence interventions have demonstrated efficacy in medication uptake; however, their use may not be fully integrated into clinic operations or their roles clearly defined. This quality improvement (QI) project developed an evidenced-based PrEP Navigation (PN) tool to identify patient-reported barriers to uptake and to support process improvement at a large community health center in Washington, DC. Outcomes related to patient-reported barriers, patient demographics, and time to medication pickup from the pharmacy were measured before and after implementation. A total of 198 patients were included in this analysis. Mean days from initial prescription to medication pickup was reduced by 1.42 days (p = .030) following PN tool implementation. The evidenced-based PN tool is modifiable to the needs of the individual clinic and the patients they care for to support wide-scale PrEP uptake and continuous system process improvements.