Utilizing Resources Through Patient Navigation

I serve in one of the many city health centers in Philadelphia. These health centers are scattered around the city, and their primary role is to replace the now defunct public hospitals with preventative-based primary care sites. Volunteering in such a setting has allowed me to immerse myself into my service work while at the same time be able to analyze my health center and the communities it serves through a discerning and analytical lens. While on the one hand I’m learning how to navigate the various organizations and institutions that comingle in Health Center #4, I also have the privilege of being able to stand back and question some of the regulatory schemas, accepted norms, and the general status quo of how things are done. My unique perspective has inspired me to make certain small changes in how I serve the community, but it’s also influenced how I intend to practice medicine in the long term. 

There are many wonderful things that happen in a city health center that I didn’t know were available for people before I started my service term. These include, but are not limited to: no-cost medication, affordable co-pays for in-house visits, free vaccinations, and pregnancy tests. What struck me most about the center was not one thing in particular, but the collective variety of different health-oriented services existing simultaneously under one roof. Typical doctors’ offices don’t include pediatrics and adult medicine in the same building, let alone the lab, radiology department, medical-legal team, behavioral consultant, nutritionist, dentist, etc. that all work together at Health Center 4.

As I’ve become more acquainted with my host site, and more comfortable with my role as a Patient Advocate, this way of organizing services has continued to impress me. It’s not a perfect system, but it seems to be a very effective way of targeting certain populations who typically have limited time and resources and who may face substantial social, psychological, or economic barriers. Instead of having to travel to multiple offices to receive several different types of services, patients can essentially fulfill most of their health needs in a “one-stop shop.” This is exceedingly important for those patients who may have trouble navigating or affording public transportation, for those who are mentally or physically impaired, or for those who are generally uncertain about how the health care system works, such as immigrants or geriatric patients. I’ve noticed that the Health Center is a place where patients begin to feel comfortable over time. Though not encouraged, it’s not uncommon for patients who are having real medical emergencies to come to the Health Center instead of going to the ER; it’s the place that they know and feel safe, and where they know there are no insurmountable financial repercussions for utilizing services.

But the awesomeness of resources is just one side of the proverbial coin. What I’ve also come to know is that while all of these services are available to patients, the integration of these resources and the patient’s knowledge of their availability and how to use them is lacking. Available services seem to work as mutually exclusive entities. Most secondary services (non-doctor’s appointments) work on different schedules and have different patient requirements (like referrals or paperwork). Most providers have only a vague idea of what the other providers can offer. At best, patients are correctly told where to go and who to see in the health center, with minor waiting times and resolved issues. At worst, patients are shuffled around between various services until they find the right one. It might be three or four hours from start to finish, and by the end their health needs may be in a similar state to where they started. Perhaps they went in to inquire about state-funded insurance, but left with an unfinished Medicaid application due to missing income documents. Maybe they’ve come in after trying to pick up medication from an outside pharmacy only to be told that their insurance won’t cover it; they’re now waiting to see the Managed Care Nurse who may or may not be able to figure out why.

These inefficiencies inspired me to begin thinking about what I can do to help connect these junctions between services. In the last couple of months in my service term, I’m attempting to put together and hopefully pilot a patient navigation project: for all new incoming adult patients, I would be available to simply meet with them sometime during their first visit at the health center and give them an overview of what services we have. Additionally, I would like to outline what strategies patients can use to make the most of their limited appointment slots, and also discuss doctor/patient expectations. The goal is threefold: to educate, to empower, and to foster a positive relationship with patients so that they will continue to utilize services. As providers—physicians, social-workers, volunteers, or otherwise—I believe that it’s not just our job to present services to people, but to also show them how to use them effectively! This kind of practice increases health literacy and gently encourages patients to further engage in their health outcomes. Transparency of available services and increased agency while navigating through the clinic will certainly lead to higher patient satisfaction because patients will be able to confidently use the resources that are available to them instead of being blindly led through these resources. 

It’s my unique position as an NHC member that has allowed me to zero in on this issue and actually have the ability to formulate a solution. I’m not constrained by a rigid job description, and am actually encouraged to use my thoughtfulness and creative problem-solving skills to evaluate the Health Center I’ve come to care about.  While I hope to implement the Patient Navigation system into the health center to directly improve patient-clinic relations at Health Center #4 for many service terms to come, I’ve also learned a valuable lesson that I hope to take with me as I continue my path into medicine and beyond: that it’s possible and important to continually challenge my relationship to the established health care system, and it’s important to encourage others to do the same. While I won’t end up reformulating all tried and true health policy by the end of my service term, I do intend on helping my patients learn about and make the most of the resources available to them. Yes, they may still face long wait times, or pay out-of-pocket for a particular medication, or even suffer through an automated robot when calling their insurance company. Inevitably, too, some folks will have access to more than others. But if each one of us can experience health on our own terms, then such annoyances will be minor inconveniences as we feel increasingly more empowered and knowledgeable about our bodies and the resources that can help maintain and improve them.
 

This blog post was written by NHC Philadelphia member Annie Maxwell.
Annie serves as a Patient Advocate at the Philadelphia Department of Public Health-Ambulatory Health Services: Health Center 4.