The Role of Patient Navigators in Building a Medical Home for Multiply Diagnosed HIV-Positive Homeless Populations.
The Role of Patient Navigators in Building a Medical Home for Multiply Diagnosed HIV-Positive Homeless Populations.
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患者导航员在为多重诊断的艾滋病毒阳性无家可归者建立医疗之家中的作用。
DOI：
10.1097/phh.0000000000000512
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Rajabiun S
中科院分区：
文献类型：
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作者：
Sarango M;de Groot A;Hirschi M;Umeh CA;Rajabiun S
补充数字内容在文本中可用。人类免疫缺陷病毒（HIV）（PLWH）感染者最有可能脱离HIV初级保健和可检测的病毒载量，包括无家可归和居住不稳定的个人以及那些被诊断患有行为健康障碍的人。以病人为中心的医疗之家（PCMH）是一种模式，促进为病人提供全面，以病人为中心，可访问，协调和优质的护理。这一举措为艾滋病毒阳性的无家可归者和居住不稳定的个人提供了患者导航，这些人被诊断患有精神健康或药物使用障碍，作为创建适应性PCMH以满足这一人群特定需求的一种手段。本分析的目的是描述患者导航员的角色和责任，作为为无家可归和居住不稳定的PLWH与行为健康共病创建医疗之家的努力的一部分。81与诊所工作人员和2个焦点小组与患者导航进行了深入的访谈。进行内容分析，以确定患者导航员的关键角色和职责。患者导航员在创建PCMH方面发挥了重要作用，他们与客户合作安排和完成预约，制定全面的护理计划，与医疗保健系统内外的提供者建立重要关系，提供全面支持以提高患者的自我管理，并协助实现住房稳定性。可能有必要调整传统的PCMH模式，以有效地满足无家可归和居住不稳定的PLWH与行为健康共病的社会，行为健康和医疗需求。一个病人导航谁可以投资时间在支持和连接这些病人所需的服务可能是一个关键组成部分，在创建一个有效的PCMH为这一人群。这些研究结果强调了患者导航员的角色和任务，这可能有助于开发针对无家可归和不稳定居住的PLWH的PCMH，这些PLWH具有精神健康和物质使用共病。这种模式的实施有可能改善特别脆弱的艾滋病毒携带者的健康结果（如保持护理和病毒抑制），从而减轻艾滋病毒感染的负担。
Supplemental Digital Content is Available in the Text. People living with human immunodeficiency virus (HIV) (PLWH) who are most at risk for falling out of HIV primary care and detectable viral loads include homeless and unstably housed individuals and those codiagnosed with behavioral health disorders. The patient-centered medical home (PCMH) is a model that promotes provision of comprehensive, patient-centered, accessible, coordinated, and quality care for patients. This initiative provided patient navigation to HIV-positive homeless and unstably housed individuals codiagnosed with a mental health or substance use disorder as a means to create an adapted PCMH to meet the specific needs of this population. The purpose of this analysis was to characterize the roles and responsibilities of patient navigators as part of an effort to create a medical home for homeless and unstably housed PLWH with behavioral health comorbidities. Eighty-one in-depth interviews with clinic staff and 2 focus groups with patient navigators were conducted. Content analysis was performed to identify key roles and responsibilities of the patient navigators. Patient navigators played an important role in creating a PCMH by working with clients to schedule and complete appointments, develop comprehensive care plans, forging critical relationships with providers both within and outside of health care systems, providing holistic support to increase patient self-management, and assisting in achieving housing stability. It may be necessary to adapt the traditional PCMH model to effectively meet the social, behavior health, and medical needs of homeless and unstably housed PLWH with behavioral health comorbidities. A patient navigator who can invest time in supporting and connecting these patients to needed services may be a key component in creating an effective PCMH for this population. These findings highlight the roles and tasks of patient navigators that may contribute to developing a PCMH specific to homeless and unstably housed PLWH with mental health and substance use comorbidities. Implementation of such a model has the potential to improve health outcomes (such as retention in care and viral suppression) for particularly vulnerable PLWH and thereby reduce the burden of HIV infection.