Patient Navigation Program

The idea that a person’s health is multi-faceted and multi-dimensional has been brought to the forefront of patient care in the past 15 years. The term “social determinants of health” is something health care providers are looking to address more and more to improve a patient’s health outcomes. Aspects of this term include economic stability, physical environment, education, food, social and community supports, and overall health care systems. All these things can have a positive or negative effect on health outcomes. Take, for example, a patient who needs treatment for an infection. To the provider, treating that infection is the top priority. However, to the patient, it may be secondary to making sure there is enough for their children or that the rent gets paid on the first of the month. Those barriers, or social determinants of health, can impede someone from getting necessary treatment.

Over 60% of our patients tell us we are their only health care provider. We take this role seriously and ensure we are addressing each patient’s areas of personal concern beyond reproductive health. The Patient Navigator Role was derived from the input of our front-line staff—our clinic nurses, physicians, and techs. They saw the necessity of going beyond the immediate clinical need, the reason the patient came into our clinic. The staff realized the patient was, in many cases, unable to meet their medical needs without addressing barriers to care categorized as social determinants of health. The Patient Navigator program began at our affiliate when the PPCWNY Development team found a donor interested in helping us address this need.

Using our electronic check-in process, we at PPCWNY screen all patients by asking questions such as: “Do you have a stable and safe place to live?”, “How hard is it for you to pay your bills?”, or “How often do you feel lonely or isolated from those around you?”.  The results of this screening tool are monitored by our Patient Navigators. They then work with the patient by setting up an appointment at the clinic or contacting them by phone, to help connect them to resources in their communities that address their self-reported needs. For example, if someone needs help accessing food for their families, they can be connected to a local food bank. If they need a safe place to stay because they are in an intimate partner violence situation, they can be connected to a local shelter.