Implementation of culturally targeted patient navigation system for screening colonoscopy in a direct referral system
Implementation of culturally targeted patient navigation system for screening colonoscopy in a direct referral system
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DOI：
10.1093/her/cyt003
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发表时间：
2013-10-01
影响因子：
2.4
通讯作者：
Redd, William
中科院分区：
文献类型：
--
作者：
Jandorf, Lina;Cooperman, Julia L.;Redd, William
低收入的少数民族往往面临基于系统和个人的障碍，以筛查结肠镜检查（SC）。采用专业导航员（Pro-PN）或基于社区的同行导航员（Peer-PN）的文化针对性患者导航（CTPN）计划可以帮助克服障碍，但尚未广泛实施。在美国纽约州东哈莱姆，大约一半的居民参加了SC，2008年5月至2010年5月期间招募了315名在初级保健诊所使用直接内窥镜转诊系统转诊接受SC的非洲裔美国患者。在获得医疗许可后，240例患者随机接受由Pro-PN（n = 106）或Peer-PN（n = 134）输送的CTPN。成功的导航通过SC依从率、患者满意度和导航员信任度来衡量。研究入组率为91.4%，Pro-PN（80.0%）和Peer-PN（71.3%）之间的SC依从率无显著差异（P = 0.178）。两组的参与者都报告了很高的满意度和信任度。这些研究结果表明，CTPN Pro-PN和Peer-PN计划在城市初级保健环境中是有效的。我们详细介绍了我们如何招募和培训导航员，CTPN是如何实施的，并提供了一个初步的答案，我们的研究目标的问题：同行导航员可以作为有效的专业人士和什么是潜在的影响，患者导航筛选依从性？
Low-income minorities often face system-based and personal barriers to screening colonoscopy (SC). Culturally targeted patient navigation (CTPN) programs employing professional navigators (Pro-PNs) or community-based peer navigators (Peer-PNs) can help overcome barriers but are not widely implemented. In East Harlem, NY, USA, where approximately half the residents participate in SC, 315 African American patients referred for SC at a primary care clinic with a Direct Endoscopic Referral System were recruited between May 2008 and May 2010. After medical clearance, 240 were randomized to receive CTPN delivered by a Pro-PN (n = 106) or Peer-PN (n = 134). Successful navigation was measured by SC adherence rate, patient satisfaction and navigator trust. Study enrollment was 91.4% with no significant differences in SC adherence rates between Pro-PN (80.0%) and Peer-PN (71.3%) (P = 0.178). Participants in both groups reported high levels of satisfaction and trust. These findings suggest that CTPN Pro-PN and Peer-PN programs are effective in this urban primary care setting. We detail how we recruited and trained navigators, how CTPN was implemented and provide a preliminary answer to our questions of the study aims: can peer navigators be as effective as professionals and what is the potential impact of patient navigation on screening adherence?