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Identifying and Removing Barriers to Care

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Sharon Gentry, RN, MSN, AOCN, CBCN …

Sharon Gentry, RN, MSN, AOCN, CBCN
Breast Health Navigator
Derrick L. Davis Forsyth Regional Cancer Center

Published in Health & Medicine , Education
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  • 1. Identifying and Removing Barriers to Care
    Sharon Gentry, RN, MSN, AOCN, CBCN
    Breast Health Navigator
    Derrick L. Davis Forsyth Regional Cancer Center
  • 2. Objectives
    Identify common barriers to care all navigators may face
    Explore solutions to address barriers
    Share experiences among navigators on overcoming healthcare barriers
  • 3. Defining Barriers
    Barriers to healthcare are obstacles within our healthcare system that prevent vulnerable patient populations from getting needed healthcare, or that cause them to get inferior healthcare compared with advantaged patient populations
    American Medical Student Association Foundation by the US Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions, Division of Medicine and Dentistry. www.amsa.org
  • 4. The Patient Navigation Model
    Freeman HP, et al. Cancer Pract. 1995;3:19-30.
    The Cancer Care Continuum
    OUTREACH
    REHABILITATION
    PATIENT NAVIGATION
    Resolution
    Abnormal results Diagnosis Treatment Survivorship
    Suspicious Finding
    Conclude Navigation
    “The core function of patient navigation is the elimination of barriers to timely care across all segments of the healthcare continuum.”
  • 5. Potential Barriers to Receiving Timely Healthcare
    Freeman HP, et al. Voices of a Broken System. Bethesda, MD: NIH, NCI; 2001.
  • 6. Types
    Geographic/cultural barriers
    Socioeconomic barriers
    Organizational barriers
    ***Combinations
  • 7. Geographic/Cultural Barriers
    Rural, suburban, inner-city…
    Baby boomer, generation X, generation Y…
    Health beliefs and behaviors
    Patient beliefs as well as practitioner beliefs
  • 8. Cultural Barriers
    Language
    Bias
    Fears
    Care
    Information
  • 9. Bias
    African Americans as a whole receive fewer cardiovascular procedures, organ transplants, orthopedic surgeries, C-sections, and lung operations for cancer
    American Indian and Alaskan Native women in the United States have a higher risk of death from cervical cancer than the general population due to low screening with Papanicolaou tests
    http://jama.ama-assn.org/issues/v283n19.http://www.idealibrary.com/links/doi/10.100/pmed.1999.0537.
  • 10. Language Barriers
    http://factfinder.census.gov.
    In the United States, 1 in 5 people speak a language other than English
  • 11. Language Barriers
    Non-English speakers have more difficulty understanding information from their doctor’s office
  • 12. Methods Used in Hospitals to Provide Language Services
    Health Research and Educational Trust, 2006 Robert Wood Foundation.
  • 13. Language Services
    Language Services
    Associates
    www.lsaweb.com
    American Language
    Services
    www.alsglobal.net
  • 14.
  • 15. Lay Health Navigators
    Community leaders who educate community members about health-promoting behaviors
    REACH 2010 Initiative/PATH for Women Program
    Eng E, et al. BreastCancer Res Treat. 1995;35:23-29.
    Nguyen T, et al. SeminOncolNurs. 2008;24: 270-278.
  • 16. Socioeconomic Barriers
    “Drivers of healthcare disparities”
    Lack of health insurance
    Inability to pay out of pocket – transportation, child care
    Poor education
    Employment
  • 17. Socioeconomic Barriers
    The Institute of Medicine (IOM) report, Care Without Coverage: Too Little, Too Late, states that uninsured patients get about one half the health- care of insured patients and consequently die sooner than insured patients, largely because of delayed diagnoses. Another IOM report, Ensuring Quality Cancer Care, cites concerns about lapses in care that can lower the chances of survival and can compromise the quality of life of cancer patients.
  • 18. Cancer. Aug 1, 2011:3546.
  • 19. Patient Protection and Affordable Care Act (PPACA)
    Public Law 111-148
    Goals – prioritize… affordability
    accessibility
    accountablilty
    tackle disparities
    Until then…
  • 20. Uninsured/Underinsured
    CancerCarewww.cancercare.org800-813-HOPE
    Georgia Cancer Coalitionwww.georgiacancer.org404-584-7720
    NeedyMedswww.needymeds.com
    Partnership for Prescription Assistancewww.pparx.org888-477-2669
  • 21. Expenses
    National Patient Advocate Foundation
    www.npaf.org
    The Cancer Survival Toolbox www.cancersurvivaltoolbox.org
    2011 Cancer Resource Guide
    www.curetoday.com
    Before treatment: Strategies to make sure you’re getting the most out of your insurance plan
    During treatment: Organization and help are crucial in managing your finances during treatment
  • 22. Expenses
    therewithcare – Colorado
    www.therewithcare.org
    The WEPAC Alliance – Kansas
    www.wepacthehouse.org
    Patrick Dempsey Center for Hope and Healing – Maine
    www.dempseycenter.org
    Mautner Project
    www.mautnerproject.org
    Tigerlily Foundation – (888) 580-6523
    www.tigerlilyfoundation.org
    Joe’s House – (877) JOESHOUSE (563-7468)
    www.joeshouse.org
  • 23. Poor Education
    More than 20% of adults read at or below a fifth-grade level ̶ far below the level needed to earn a living wage
    Nearly half of America’s adults are poor readers, or “functionally illiterate.” They can’t carry out simply tasks, such as balancing a check book, reading a drug label, or writing an essay for a job
    21 million Americans can’t read at all, 45 million are marginally illiterate, and one fifth of high school graduates can’t read their diplomas
    National Institute for Literacy, Fast Facts on Literacy, 2001.National Adult Literacy Survey.
  • 24. ONS Connect. July 2011.
  • 25. Employment
    “Those with jobs”
    Cancer and Careers
    www.cancerandcareers.org
    The CHAIN Fund
    www.thechainfund.com
    (203) 530-3439
  • 26. Organizational Barriers
    Physical ̶ How accessible is your care?
    Can the patient find it?
    Communication
    Unspoken
  • 27.
  • 28. Communication
    Insufficient culture-sensitive information.
    Drop out – give up in misunderstanding
    or frustration
    Being there…trust
    Negative research experiences
  • 29. Information
  • 30. System
    Politics of the system
    Squeaky wheel
    Favorite patients/cancers
    Outcome measures
    PROMIS
    FAMCARE
    Distress thermometer
    Tracking logs
    Patient satisfaction scales
    Supplement to Cancer. Aug 1, 2011.
  • 31. Improve Patient Care
    Cancer Patient Navigation Programs are designed to help patients receive the best care possible. And they help the team that serves patients provide better care. Cancer Patient Navigation is not the cure for the disease, but it can be the lifesaver for the patient.
  • 32. “broker”
    “key”contact person
    pivot nurse
    spoke of the wheel