A. C. Matousek1,3, J. Denike2, S. R. Addington1, C. Exe2, R. R. Jean-Louis2, J. G. Meara3, R. Riviello1,3 1Brigham And Women’s Hospital,The Center For Surgery And Public Health,Boston, MA, USA 2Hospital Albert Schweitzer,Deschapelles, ARTIBONITE, Haiti 3Harvard Medical School,Program In Global Surgery And Social Change, Department Of Global Health And Social Medicine,Boston, MA, USA
Introduction: In the catchment area of an NGO hospital in rural Haiti, the surgical service rate among the poorer population from mountainous areas is much lower than in the relatively wealthier population living in valley areas, despite the presence of a free care program for the poor. Potential additional barriers for mountain patients may include low literacy levels, lack of awareness of the free care program, unfamiliarity with the hospital system, long distances to travel and high opportunity costs. We sought to increase the elective operation rate among patients from a mountain population with a surgically treatable condition using a patient navigation (PN) program.
Methods: A surgical resident screened potential subjects with a physical examination at a mobile health post in the mountain region. Subjects responded to a questionnaire regarding their symptoms and knowledge of the free care program. Subjects with more severe disease were given priority. Patient navigators (PNs) were trained to guide subjects through an initial clinic visit for elective surgery from March 10 to July 1, 2014. A control period from December 10 to March 1, 2014 was used for comparison. The rate of elective operations per 10,000 population was measured across a mountain control group, a valley control group and the PN group both during the control period and during the PN program.
Results: Surgical conditions were found in 86 of 136 subjects who presented for screening (63.7%). Subjects had experienced symptoms for more than two years in 70.3% of cases. Less than 5% of subjects claimed any prior knowledge of the free care program and only 34% could write their name. PNs successfully guided 41 high priority subjects who received operations during the study period. After controlling for temporal trends across the two control groups, the elective operation rate in the PN group increased from 0.91 operations per 10,000 population in the control period to 5.05 operations per 10,000 population with PN (p = 0.002). The rate of urgent surgical operations remained the same across all three groups.
Conclusions: A PN program was able to increase the rate of elective surgical operations for a vulnerable population in rural Haiti. While additional barriers remain, PN appears to be an effective augmentation to free care programs to ensure equitable access to surgical care for the poor.
