• World journal of surgery · Dec 2017

    Comparative Study Controlled Clinical Trial

    Patient Navigation by Community Health Workers Increases Access to Surgical Care in Rural Haiti.

    • Alexi C Matousek, Stephen R Addington, Joseph Kahan, Herriot Sannon, Thelius Luckner, Chauvet Exe, Rodolphe R Eisenhower Jean Louis, Stuart Lipsitz, John G Meara, and Robert Riviello.
    • The Center for Surgery and Public Health, Brigham and Women's Hospital, One Brigham Circle, Suite 4-020, 1620 Tremont Street, Boston, MA, 02120, USA. amatousek@partners.org.
    • World J Surg. 2017 Dec 1; 41 (12): 3025-3030.

    IntroductionIn the Hôpital Albert Schweitzer district in rural Haiti, patients from mountain areas receive fewer operations per capita than patients from the plains. Possible additional barriers for mountain patients include lower socioeconomic status, lack of awareness of financial support, illiteracy and unfamiliarity with the hospital system. We sought to increase the rate of elective surgery for a mountain population using a patient navigation program.Materials And MethodsPatient navigators were trained to guide subjects from a mountain population through the entire hospital process for elective surgery. We compared the rate of elective operations before and after the patient navigation intervention between three groups: a control group from a mountainous area, a control group from the plains and an intervention group from a mountainous area.ResultsThe baseline elective operation rate differed significantly between the plains control group, the mountain control group and the mountain intervention group (361 vs. 57 vs. 68 operations per 100,000 population per year). The rate of elective surgery between the two mountain groups was not statistically different prior to the intervention. After the intervention, the elective operation rate in the mountain group that received patient navigation increased from 68 to 131 operations per 100,000 population per year (p = 0.017).DiscussionPatient navigation doubled the elective operation rate for a mountain population in rural Haiti. While additional barriers to access remain for this vulnerable population, patient navigation is an essential augmentation to financial assistance programs to ensure that the poor gain access to surgical care.

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