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A4842 - Clinicians' Perceptions of Patient Advocates Attending Asthma-Related Medical Appointments
Author Block: H. Park, H. Black, L. Perez, A. Localio, G. Ndicu, A. J. Apter; Division of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
Rationale: Patient navigators have been used in clinical settings to improve access and communication. This qualitative study evaluates the perspectives of healthcare providers regarding a patient navigator, called a Patient Advocate (PA), in a randomized controlled trial of a PA versus usual care to improve asthma outcomes for low-income and minority adults with uncontrolled asthma. The PA, a recent college graduate, attends patient-clinician appointments and performs the following tasks: meets with patients prior to an asthma-related medical visit, helps the patient formulate 2-3 questions important to address at the appointment, attends the medical visit with the permission of patient and clinician, and afterwards completes teach-back (i.e. confirms understanding of clinician’s recommendations). At the medical appointment, the PA is strictly an observer.
Methods: Clinicians were invited to participate in focus groups if they had at least one patient appointment attended by a PA. Clinicians who declined to participate were offered a 30-minute interview. Using a semi-structured interview guide, clinicians were asked to reflect on their awareness of PA duties, impact and design of the program, and its potential. All focus groups and interviews were audiotaped, transcribed, and then independently coded by two researchers.
Results: Eighteen of 30 invited clinicians participated: 6 in focus groups, 12 by interview. Mean age was 51 (range: 33-75), 10 female, mean years in practice 16 (range: 2 to 30), 12 were asthma specialists, 6 primary care clinicians. Four areas of inquiry from the focus groups and interviews were: 1) perception of the PA program, 2) clinicians’ understanding of the PA role, 3) impact on patients, and 4) value of the PA program. Clinicians reported that while interactions with PAs were limited, workflow was not negatively impacted and the PA presence helped reinforce recommendations. The role of the PA was seen as different from traditional clinical roles, emphasizing follow-up with patients (teach-back) to facilitate understanding and continuity of care. Clinicians noted an improvement in patient engagement during the medical visit. Overall, clinicians thought the PA program had potential value in affecting health outcomes and patient satisfaction.
Conclusions: To clinicians, attending patient appointments is a unique activity for advocates who traditionally focus on navigation activities and resolving administrative problems. The PA has the advantage of seeing patient-clinician interactions, to not only better guide teach-back but also to assist providers in care delivery to patients.