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Cancer Patient Navigators ForumNovember 8, 2012"Patient Navigation in Kentucky: Then and Now"Presented by: Fran Feltner, DNPDirectorUniversity of Kentucky Center for Excellence in Rural Health1

Working to improve the health of Kentuckys rural people through education, research, service and community engagement.Our MissionBailey-Stumbo Building, Hazard, KYUK Center for Excellence in Rural Healthwww.kyruralhealth.org2Organization of this PresentationIntroductionProblems IdentifiedWhy Patient Navigation is NeededPast/Present Programs HighlightedOverview of Progress MadeOutcomes/Results Todays Community Health Workers Navigators Roles Q&A/Discussion

3Problems Identified

4Barriers To Health Care Access In Rural AmericaAccess to the Health Care SystemLack of Understanding of How to Navigate the Health Care System Uninsured/Underinsured/UnderservedTransportation Access to Primary ProviderAccess to MedicationsHealth LiteracyEducation on IllnessCommunication (culture)

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http://www.dailyyonder.com/number-rural-uninsured-grows-recession/2012/10/01/4489By 2010, according to data from the U.S. Census, more than 7.6 million rural Americans under the age of 65 lacked health insurance, up 300,000 from just five years earlier.6Health StatusHigh rates of obesityLow levels of physical activityPoor nutritionLack of preventative health servicesHigh rates of smoking7Criteria for diabetes belt - 11% or higher told by a health professional they have type 2 diabetes

Do you now smoke cigarettes every day, some days, or not at all? (from BRFSS)Every day or some daysNational rate is 17.3%Kentucky rate is 24.8%Homeplace population rate is 33.9%.

Over 90% of study population is considered overweight or obese based on BMI.

Physical activity level of Homeplace population is 33.9% as compared to over 70% for Kentucky and nation.

7Treatment BarriersTransportationOut-of-County residentsNo one to bring patientMedical BillsUnder-insured or no insuranceMedicationCo-PaysNo Insurance

During registration, the PN meets with each new patient to explain the services offered to them while they receive treatmentA screening is done to see if the patient needs assistance with barriers not only in cancer treatment, but also with any health related matter

Availability + Access Utilization

G. H. Friedell, M.D.May 2, 19949Overview of Progress

10Gil Friedell, M.D., Director Emeritus University of Kentucky Markey Cancer Center

Mountain SC-Outs ProgramSpecially-trained female staffOne-on-one interviewsCounties with high cervical cancer rates Informed women about options for early cancer detection services.

Many underserved women received: MammogramsPap SmearsPreventive Care

11In the early 1990s many rural Kentuckians were going without health care services, and in particular, preventive care. The Commonwealths General Assembly took the unique step in 1994 of earmarking taxpayer money for Kentucky Homeplace.

KY HOMEPLACE HISTORYThe first program in the Community Health Division was established in 1994 and was given the name The Kentucky Homeplace ProgramDeveloped a training manual and job description of the CHWs12KENTUCKY HOMEPLACEThe mission of Kentucky Homeplace is to provide access to medical, social, and environmental services for the citizens of the Commonwealth. Vision/Goals Statement

To educate Kentuckians to identify risk factors and use preventative measures to become a healthier people with knowledge and skills to access the healthcare and social system.

Mission

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SERVICE AREA

38 counties served with 255 CHWs in each region14DR HAROLD FREEMAN Patient Navigators coordinate a patients individual care, and serve as invaluable resources for patients and their caregivers, who might otherwise be discouraged by a variety of barriers. No person with cancer should be forced to spend more time fighting their way through the healthcare system than fighting their disease.In the early 1990s DR Freeman began working with the population in NY with high mortality rates and late detection of cancer due to patients who were not receiving preventative care/screening. Roberts StoryTestimonies were given from our Kentucky Team (Dr Gil Friedell and Fran Feltner speaking about Harlan KY and DR Harold Freeman speaking about Harlem NY.16Statement on H.R. 1812, the "Patient Navigator Outreach and Chronic Disease Prevention Act of 2005"

17Solutions IdentifiedCHWs/Navigators

http://www.cancerpatientnavigation.org/toolkit.htmlGil Friedell, M.D. Who can be navigators?18Health Policy Newsletter Vol. 22, No. 2 June 2009Patient navigators may be community health workers, lay health educators, peer health promoters, medical assistants or nurses who serve as liaison between patients and providers to promote health among groups that may lack access to adequate health care. The purpose of a Patient Navigator is to help reduce health care disparities; facilitate communication between patients and providers; assist patients in overcoming barriers to care; shape perceptions individuals may have about disease and specific health-related behaviors; provide outreach services and educational support; and offer culturally and linguistically competent assistance.

DR Freeman quote19Past and Present Program HighlightsMental Health OutreachSoutheast Kentucky Community Access ProgramHealth BuddiesColon Cancer Prevention and ScreeningMarcum & Wallace Memorial Hospital Emergency Room NavigatorARH/UK Markey Affiliate Cancer Center Patient Navigator Program

20Past Program PUBLISHED Outreach and Education for Colorectal Cancer Screening Using CHWs Homeplace CHWs enrolled 637 clients in a colorectal cancer prevention study.

Results:The mean score of the 637 participants increased from 4.27 at baseline to 4.57 at follow-up (p