BACKGROUND: This review was carried out to synthesize the evidence of the effectiveness of community health worker (CHW) navigation in primary care chronic disease management.
METHODS: We searched the English language literature between January 1990 and March 2020 in Medline, Embase, Emcare, PubMed, Psych Info, CINAHL, Scopus, and Medline Epub ahead of print. Data extraction, quality rating, and assessment of the reporting of interventions were performed by two reviewers independently and the findings were synthesized narratively.
RESULTS: Twenty-nine articles met the inclusion criteria. All but two were carried out in the USA and half were randomized controlled trials. Six of the 29 studies were of strong methodological quality while 12 were moderate and 11 weak. Overall, CHW navigation interventions were effective in increasing adherence to cancer screening and improving use of primary care for chronic disease management. There was insufficient evidence that they improved clinical outcomes or risk factors and reduced use of secondary or tertiary care or that they were cost-effective. However, criteria for recruitment, duration, and mode of training and supervision arrangements varied greatly between studies.
DISCUSSION: CHW navigation interventions improved aspects of chronic disease management. However, there is insufficient evidence of the impact on patient experience, clinical outcomes, or cost-effectiveness of the interventions. Future research should focus on standardizing organizational components of the CHW navigation interventions and evaluating their cost-effectiveness.
PROTOCOL REGISTRATION: The review protocol was published in PROSPERO (CRD42020153921).
This is a well done systematic review, utilizing PRISMA guidelines with conclusion that we don't have enough information to say much about the topic, but the question is certainly relevant.
As a geriatrician, I am painfully aware of the difficulty my patients have navigating the health system. I see patients who are taken care by multitude of specialties when primary health can do the job better. In my view, cost effectiveness should not be the deciding factor here rather the simplification of how to direct patients with chronic diseases to their primary health care provider. Where I work I am not aware of the presence of CDWs, but this article opened my eyes to suggest the establishment of such.
Navigators to improve care and reduce cost seems like a good idea. This analysis attempts to aggregate data from multiple studies but there are too many variables to make solid conclusions. We do know that healthcare is fragmented. For the elderly, vulnerable and disadvantaged coordination of care is often suboptimal. Navigator competencies, arras of focus are yet to be clearly defined.