Tackling Barriers to Healthcare Through Patient Navigation

Going into my service term, I had a general idea of the challenges patients faced when navigating the healthcare system. Through my service, I have realized just how multifaceted these challenges are. Low health literacy and lack of insurance are two of the most common issues I come across. Low health literacy affects not only the patient’s ability to comprehend what is discussed during the appointment or the after visit summary, but also impacts their understanding of the importance of preventative care. Annual physicals and recognition of baseline as an indicator for any abnormalities which may arise are crucial to patient health. Insurance, from the patient’s perspective, presents itself in the form of a premium, copay, or deductible and can become a barrier if the patient is uninsured or underinsured. If the patient’s costs are too high, he or she may wait until their condition is more advanced or life threatening, or opt out of having insurance altogether, increasing their use of the emergency room and overall medical expenses instead of seeking care for their initial, more treatable disease or condition.

          "Hello, this is Andrea, Patient Navigator at St. Margaret’s Lawrenceville Family Health Center. I am calling on behalf of your doctor to speak with you about your routine health screenings. Is right now a good  time to talk?"

          "Health screenings…I don’t know what that is."

When I realized I could not explain preventative health screenings in a way that patients would understand, I consulted my mentors. I thought back to one of our first trainings with Becky Carpenter of the Greater Pittsburgh Literacy Center. She spoke about the current state of literacy in Allegheny County and how low health literacy can be a barrier that patients faced when interacting with the healthcare system. We discussed how low health literacy could appear during a typical office visit: not completing check-in questionnaires, difficulty understanding visit summary/diagnosis papers, or misunderstanding prescriptions and how and when to take them. This training not only made me aware of this barrier, but also made me actively change my language and approach to discussing preventative screenings and vaccinations. Dexa scan? Imaging test to check your bone density or thickness. Mammogram? Test where pictures are taken of your breast tissue to check for anything out of the ordinary. The CDC also has handouts that are more patient-friendly in describing health screenings, which have become a useful tool for patient outreach.

Many patients are unaware that even if they lack insurance or are underinsured, there are resources available to help them with their preventative healthcare needs. My main role at my service site is to contact patients to ensure their health maintenance is up to date and help them with any barriers they may encounter that prevent them from achieving their health goals. The first patients I contacted when I started my service term were those with three or more outstanding health screenings, many of whom would express that they were without insurance. Older patients often told me that they were waiting until they turned 65 to go to the doctor, even for a physical, because that was when their Medicare plans began. Others expressed that their copay was so high that they avoided seeing a physician for anything other than acute care. For these patients, I am always excited to share that there are resources available for them to receive free or reduced care through the Adagio program. Founded in 1971, Adagio Health has partnered with health centers to provide women with obstetrics and gynecology, breast and cervical cancer screenings, STI testing and treatment, nutrition counseling, teen pregnancy prevention, HIV prevention, sex education for teens, and other community health services. They also provide healthcare services for men including routine reproductive health exams, blood pressure evaluations, and colorectal cancer screenings for individuals over 40 years of age. Although there is not a single solution to tackle these barriers, through the use of programs such as this and continuous improvement of communication with patients we are able to work towards creating healthier communities through preventative care.

This post was written by NPHC member Andrea Grey.

Andrea serves at UPMC St. Margaret Lawrenceville Family Health Center as a Patient Navigator.