Southside Pain Patient Pre Appointment Online Questionnaire

Report Blueprint

Participants completed a baseline questionnaire (via staff interview) at enrollment that included questions about demographics, health status/needs, healthcare utilization, and admission/barriers to care. I-yr post-enrollment and following completion of the ED-PN intervention, a research assistant not directly involved in PN conducted follow-upwards phone surveys to assess participant-reported healthcare utilization, access/barriers to care, and program satisfaction. Follow-up survey completion had no bearing on receipt of ED-PN. Survey questions included novel and validated questions to measure health literacy,^29
,
30
healthcare utilization,³¹
health condition,³²
and cocky-efficacy for managing chronic diseases³³
(Appendix A). Surveys were piloted with patient navigators for comprehension and lasted approximately 15–30 minutes. Responses were collected using a web-based platform (Qualtrics XM, Provo, UT). Respondents received a $25 souvenir card for participation.

Upon completion of the follow-up survey, English language-speaking ED-PN participants were invited to participate in a qualitative interview virtually the PN program. The study team developed the interview guide, which was reviewed past patient navigators for understandability and iteratively revised (Appendix B). The interviewer had not previously interacted with whatever of the participants. Audiorecorded interviews were approximately 45–60 minutes in length and transcribed verbatim. Interviews were conducted until thematic saturation was reached. Participants received a $50 gift card for completing the interview. Interview and follow-up survey completion occurred following completion of ED-PN intervention. Participants were informed that participation in these assessments had no bearing on current or futurity services received. This study was approved by the Yale University Institutional Review Board.

Patient Interview

The coding structure and categories followed the topical framework of the interview guide and were iteratively refined through group discussion. The coding nomenclature scheme was finalized by consensus and applied to each transcript by at least two contained reviewers. Whatsoever coding discrepancies or ambiguities were resolved through word. Codes were applied to each transcript using ATLAS.ti version 5.2 (ATLAS.ti, Berlin, Germany). The report team reached consensus on a concluding thematic framework and identified illustrative quotes that represented the responses relevant to each theme.

Interview Results

We conducted 11 interviews. Compared to the ED-PN group, most interviewed participants (due north = xi) were female (82% vs 67%) and Black (55% vs 47%) and fewer had full-time employment (9% vs eighteen%). Interviewees were otherwise similar to the overall ED-PN group in their sociodemographic characteristics and reported health (Tables 1
and
​
2). Iv main themes emerged: i) Patient nagivators were perceived as effective healthcare coordinators and advocates who provided continuity and individualized support (Theme 1); 2) health-related social needs were frequent drivers of and barriers to healthcare utilization that required PN assistance (Theme ii); three) main care utilization depended on dispensary accessibility and quality of interpersonal relationships with providers and staff (Theme 3); and four) participants characterized the ED equally providing user-friendly, comprehensive intendance for urgent needs and filling gaps in chief intendance access (Theme 4)(run across Supplemental Tabular array).

Theme 1: Patient navigators perceived equally effective healthcare coordinators and patient advocates who provided continuity and individualized back up.

Participants provided unanimously positive feedback about PN support. Many described feeling relieved about finally receiving the assistance they felt they needed. One participant observed, “You feel like nobody elsewhere is helping you and they’re at that place to help… I was at my wit’s end when [the PN] came to me. I was and then fed upward.” (Participant five)

Strong PN-patient relationships were consistently cited as a central program component. One participant described their relationship with the patient navigator as, “Wonderful… I felt that they cared, they actually cared, non just about me, simply actually me.” (Participant ten) Participants linked this directly to the development of self-worth and trust. PN services were viewed as non-judgmental, unconditional, and made participants feel comfortable. “They made me feel similar, ‘This is my paw extended out to you, whether you want it or yous don’t.’ They didn’t brand me feel bad, they made me experience comfortable.” (Participant 8)

Patient navigators besides educated participants about healthcare utilization and what to expect from healthcare visits. Some participants said this allowed them to “[Know] my rights a picayune flake more.” (Participant 6) Drawing from PN education and support, participants described developing improved self-efficacy navigating the healthcare system. One participant reported feeling, “More than comfortable to go back to my principal care doctor and say ‘Hey, you lot’re my chief care dr., yous’re supposed to be the one to come across me and give me care’… I felt stronger… I felt empowered to make an appointment.” (Participant 6) The participant connected: “Within a year, I was able to…go to the primary care physician, go to the dentist. I was able to get going, I became familiar. I was driven, I … wanted to participate in my ain care.” (Participant vi)

Participants described developing very strong bonds and trust with their patient navigators and indicated that they made a noticeable difference in their lives. One participant described, “If it wasn’t for [the PN] I’thou telling you; I wouldn’t have been at none of these appointments. If information technology wasn’t for [the PN] checking on me, calling me, asking ‘did y’all do this, did you do that,’ I really was lost.” (Participant viii)

Theme 2: Navigators helped patients accost health-related social needs that were drivers and barriers to healthcare utilization.

Social, economic, and personal considerations were mutual factors that impacted participants’ healthcare utilization. Several participants commented that navigators helped them prioritize their health and healthcare appointments despite social barriers and competing concerns. One noted, “[The PNs] helped out because when I accept then many things on my listen, like … my daughter and her homework, or me trying to discover the, not the right job, simply the most beneficial employment… Is there food in the house, does she have the right shoes, this and that…So, for you to call me and remind me [to go to my appointments], that’s a cute thing.” (Participant iv)

Transportation, caregiver responsibilities, and housing were unremarkably cited barriers to accessing principal intendance. Patient navigators frequently assisted with transportation. One individual noted: “for bus passes you lot got to phone call seven days before and sometimes it’d come the day later on my appointment, but if I called [the PN], they’d go right on that phone, call transportation and they’d transport me a taxi that morning for my appointment.” (Participant 10)

A number of participants experienced major life events, such as incarceration of family unit members or family health problems, that impacted their wellness, further demonstrating that additional back up is be needed across the scope of the PN program. In such situations, navigators directed patients to local resources and provided emotional support. While most participants did non report receiving assistance with health-related social needs (Figure, Panel C), participants who did use these services reported positive experiences. However, the ED-PN intervention was not designed for comprehensive navigation to address these needs. During the form of the report, staff often noted feeling limited in their ability to address health-related social needs, particularly housing.

Theme three: Master intendance utilization was driven by clinic accessibility and quality of interpersonal relationships

Engagement availability, interactions with clinic providers and staff, and perceived intendance quality, thoroughness, and continuity were usually mentioned factors impacting main care utilization. Provider continuity and familiarity with one’south past medical history cultivated trust and condolement. Nevertheless, many participants who received care at the principal care resident clinic connected their decreased clinic utilization to their dissatisfaction with the dispensary stemming from lack of trust in providers, feeling rushed during appointments, and lack of conviction in the quality of clinic care.

The loftier volume of patients at the primary intendance dispensary and perceived lack of organisation were viewed as compromising patient intendance. Explained one participant, “With the main intendance clinic, is for one they are overpopulated. They’re non able to appraise each patient the way that they should…It’southward always hectic… when y’all walk into the clinic, yous can just experience the energy of people waiting for 2 and 3 hours to be seen by a medico. It’s no organization in the waiting room. It’s a mess. The dispensary is a mess.” (Participant 6)

Participants were also frustrated with lack of provider consistency at the primary care resident clinic. One participant explained, “You lot don’t want to continue seeing unlike people. You want to meet the same person…You’re always bounced effectually to different people where you lot’d have to explicate your whole story to because they don’t know yous. So, at that place goes your fifteen minutes right there.” (Participant 5)

Several patients commented that PN accessory to primary care provider visit(s) was benign and improved their overall experience of care. 1 noted: “[The PN] helped me realize you’re paying for this; yous have the right to enquire questions… and that helped me out a lot.” (Participant 8) Another participant described being treated differently when the PN attended her appointment: “They were all so squeamish, never happened earlier… I don’t know if they’re intimidated… considering she was a woman with a badge, dressed up nice, paperwork folders… I was treated perfect.” (Participant v)

Theme 4: Emergency department provides convenient, comprehensive care for urgent needs and fills gaps in principal care admission.

Virtually participants used the ED to fill up gaps in primary care and described the ED as a convenient identify to obtain comprehensive care for urgent needs. When weighing options for where to seek care, patients frequently viewed the ED every bit the only available pick for urgent needs. Said i participant, “I simply said, ‘Forget about [making an date].’ I couldn’t have the pain anymore. Then, I ended up in the emergency room.” (Participant ane)

Illness acuity in combination with other issues, especially limited transportation, also brought people to use the ED. Inability to get a timely date was oft mentioned equally a reason to use the ED. “When I tried to call the primary care centre, they weren’t bachelor the style I needed them to be available,” said one participant. She continued, “If I felt in that location was something important and medically urgent and to them it wasn’t, I wanted it that same 24-hour interval and they would exercise 3, iv days later and I felt to myself it was important, I would just go straight to the ED.” (Participant 5) Waiting to be seen in the ED was not viewed positively, only not necessarily a deterrent given perceived or actual disability to get timely master intendance appointments. Described one participant, “It’s normal to be a long wait [at the ED]. I don’t bash that. Sometimes it’s agitating only there are and so many people like me out there that can’t get aid at primary care doctors and physicians that they get then packed.” (Participant five)

After the program, several participants recognized the benefits of using principal care for comprehensive care and the ED for discrete problems. Ane participant described, “If you lot go to the main care it’due south like y’all’re having an appointment, they can check everything that you recall could possibly be wrong with you lot at this point in time. But when you become to the ER, you’re treated for whatever y’all came there for. Similar I broke my human foot, but I take a cough, they’re gonna treat your foot, but not the coughing.” (Participant 12)

Some participants reported continuing to use the ED after the ED-PN intervention when they were acutely ill, unable to go a chief care appointment, or due to hours of operation. A few participants noted that they preferred the convenience and perceived comprehensiveness of ED intendance. They besides acknowledged that being seen in the ED could also expedite access to outpatient care. One participant described, “And you lot know, [ED providers] will get things going… I know that in one case I get in the back, one time I tell them what is going on, they will practise a CT scan, they will do 10-rays, they will do all the emergencies that could be going on with me and refer me to my doc and so I’ll get an date to my primary care sooner.” (Participant six)