Background/Purpose: Early and sustained access to rheumatology care can improve access to disease-modifying medications and reduce disparities in outcomes. In one state, more than one-half of community health center (CHC) medical directors felt that their predominantly low-income, underserved patients required better access to rheumatology care. We pilot tested an intervention that utilized a patient navigator- a layperson trained to provide a range of education, advocacy and care coordination services- to improve access to rheumatology and musculoskeletal care.  

Methods: We partnered with a CHC that cares for over 30,000 patients each year, 95% with income levels below 200% of poverty. The CHC medical director identified an affiliated community health worker to serve as the patient navigator. We developed a rheumatology/musculoskeletal disease curriculum to train the navigator and provided comprehensive patient resources and pamphlets for distribution. We identified established patients with rheumatic and musculoskeletal diseases by ICD-9 code, and primary care providers (PCPs) confirmed whether each patient would benefit from the navigator’s assistance. All patients requiring a new rheumatology appointment were also referred to the navigator. We conducted semi-structured interviews with patients to assess need and tracked all navigator services provided.

Results: Of the 695 patients initially identified by ICD-9 code with possible rheumatic and musculoskeletal diseases, 125 were referred to the navigator; 29 also required new rheumatology appointments. On average, 5 new referrals (range 2-10) were received weekly. After 3 months, 31 (28%) patients were actively working with the navigator, 81 (72%) patients’ PCPs were actively in communication with the navigator, and 62/81 (77%) of these patients were in the process of being engaged (outreach attempts made or waiting for appointments to be scheduled). Two of the 125 (2%) patients declined participation. Among the 31 actively engaged patients, navigator’s services included direct coordination of appointments and repeated reminders prior to the visit (n=26, 84%), facilitation of communication between providers (n=31, 100%), transportation arrangements (n=7, 23%), financial services including provisions for affordable medications (n=4, 13%), coordination of live interpreters (n=2, 6%), and organization of senior services (n=2, 6%). Of the 29 patients scheduled to see rheumatologists, 14/17 (82%) successfully kept their appointments and 12 appointments are upcoming.

Conclusion: This CHC-based rheumatology navigator pilot demonstrates the feasibility and acceptability of subspecialty navigators to improve access to care for underserved patients. Further research is needed to assess the effectiveness and costs of the patient navigator.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/improving-access-to-subspecialty-care-for-underserved-communities-a-rheumatology-patient-navigator-pilot-intervention/