Lack of transportation, language barriers and fear of medical procedures keep low-income Latinos out of the doctor’s office. Now a relatively new position in the health-care industry, known as a patient navigator, promises to help this population get the medical care they need.
“Poor people meet barriers when they try to go through the health-care system that cause them be treated later for certain diseases like cancer, so they end up dying at a higher rate,” said Harold Freeman M.D., a New York surgeon who came up with the idea for patient navigators in 1990 to help indigent cancer patients in the Bronx.
Freeman’s idea — creating a social worker-type position to overcome those barriers — didn’t start to catch on until 2005, when former President George W. Bush signed into law the Patient Navigator and Chronic Disease Prevention Act. Now the American College of Surgeons are requiring that hospitals that want to receive its accreditation have patient navigator programs.
Navigators guide patients through every step of their medical care. They may go to doctor’s visits to help a patient understand a diagnosis, remind her about an upcoming appointment or look for grant money to help pay for a costly operation.
A Trend That Keeps on Growing
Freeman opened an educational institute in New York last year that has trained 500 people from 41 different states to be patient navigators.
Today there are more than 2,000 health-care sites around the country that have patient navigators.
One of those is Denver Health, a conglomeration of health-care programs for low-income residents in the city and county of Denver.
Denver Health, which employs 15 navigators, works with 160,000 patients a year. More than half are Latino and nearly as many do not have health insurance. The navigators work with patients at risk for or suffering from a variety of illness such as diabetes, cardiovascular disease and breast cancer.
A director of two of the programs in the clinic, Elizabeth Whitley, says she likes to hire navigators who understand the community.
One of those hires is Raquel Vázquez de López, who works for Community Voices in the area of colorectal screening.
Vázquez de López’s job is to get middle-aged patients screened for colon cancer. She hears numerous reasons why a patient might be hesitant to get a colonoscopy: From fear of missing work (in which case she’ll call the employer) to a belief that they won’t be able to find someone to drive them home (in which case she’ll find them a taxi voucher or a neighbor willing to help out).
“I address all the barriers,” she says. “And they’re very grateful. I think they feel appreciated that someone cares about their health.”
Helping Those Who Fear the Worst
One of the most common barriers is fear. So Vázquez de López will spend extra time with that patient explaining the procedure.
“A lot of patients hear from friends and family members that it’s a very painful procedure,” she says, “so they’re surprised when I tell them it’s actually very simple, it doesn’t hurt and usually only takes about 15 minutes.”
Four years ago, when Vázquez de López first began working for Community Voices, the no-show rate for colonoscopies was 57 percent. Today it’s 17 percent.
She says even when she’s unsuccessful in convincing a patient to have the procedure right away, she often finds out that she’s had an influence.
“I try my best but sometimes they still say, ‘No,’ so I say, ‘Okay here’s my phone number, you can call anytime.’ Often a month or so later, I’ll hear from them.”
Nancy Averett is a freelance writer based in Cincinnati, Ohio.