Practical Pearls: Navigating a Patient’s Roadmap through Effective Care

The focus of this article is to provide a guide for clinicians and patients to effectively navigate the healthcare system in general, as well as in terms of specific lipid-related health concerns. Lennert Griese et al. in their 2020 article, “Challenges in Navigating the Health Care System: Development of an Instrument Measuring Navigation Health Literacy”1, discuss a patient's need for ‘navigational health literacy’ to orient themselves within healthcare systems. In this study, questions were refined for a large test-group of patients to measure the potential challenges encountered in traversing healthcare systems. Although these questions from the study have been used to understand challenges related to health literacy, they can, with modification as noted below, also be used as a practical guide for patients needing an overall road map for their care. Understanding the central factors outlined below will increase a patient’s health literacy, ultimately saving the patient time and money, as well as decreasing the likelihood of developing progressive and possibly life-threatening conditions. When patients know to ask the right questions, they feel empowered in their care. 

Items for patient consideration:

  1. Understand, in general, what services the health care system offers relative to the individual patient’s medical concerns.
  2. Determine which type of health service is needed, ideally in discussion with a primary care provider, in a shared decision-making model.
  3. Ascertain to what extent the individual’s health insurance covers a particular service [e.g., are there any co-payments, what benefits are included in the plan?].
  4. Understand information about ongoing reforms that might affect the patient’s health care [e.g., are there changes to medicare or medicaid policies, have demographics such as place of work been updated for the contract with the health insurance provider, are there relevant changes to the Affordable Care Act?].
  5. Investigate one’s individual rights as a patient or user of the health care system [e.g., religious exemptions, Health Insurance Portability and Accountability Act (HIPAA)].
  6. Locate information on the quality of a particular health service [e.g., reviews, word of mouth, publicly accessible data reports, recommendations from other providers].
  7. Be aware of rules & requirements for accessing and using the particular health care system [e.g., are referrals required, how are appointments booked, when’s the soonest available appointment?].
  8. Ask about support options that may provide orientation in the processes and procedures of the health care system [e.g., are there language interpreters if needed, are there counseling options outside of care appointments?]. Patient resources like learnyourlipids.com are extremely helpful for lipid-related health problems external to a particular provider.
  9. Locate the right contact person for the current clinical concern within a health care institution [e.g., scheduling and billing questions are typically reserved for office staff, medication refills with the pharmacist, etc.].
  10. Determine whether a particular health service provided met expectations and intentions for health care [e.g., how was the first appointment, did the provider address concerns appropriately?].
  11. Advocate for oneself in a diplomatic and courteous manner if the healthcare offered does not meet individual needs [e.g., voice concerns, ask for written documentation].

Optimally, by asking questions such as these, patients will navigate through the above items and seamlessly find themselves in the Lipid Clinic when they need to be there. By encouraging patients to ask the following questions to the outlined individuals in the care team, patient participation in lipid related care is enhanced and health concerns may be resolved in a more effective manner: 

Primary Care Provider

  1. If lipid panel results are abnormal, is there a need to be referred to a specialist? 
    • If so, how is that referral done?

Lipid Specialist

  1. Is there a lower cost alternative for laboratory tests?  
  2. Is the entire care team (primary care, pharmacist, etc.) able to access all of these test results, notes, and recommendations?
  3. What are the individual target values for lipids and other testing? 
  4. What are specific individual recommendations for achieving cholesterol goals?
  5. How will I know when we have reached my cholesterol goal? 

Pharmacist/Nurse Navigator

  1. Is there a generic option for this medicine? 
  2. Are manufacturer coupons, or foundation grants available?
  3. Do other pathways exist for obtaining medications (e.g. CostPlus Drugs, GoodRX)?
    • Are there any other ways to lower the price of my medications (e.g. discount card programs)?
  4. If questions arise about how and when to take the prescribed medicine, who will address those issues?
    • What form of communication is best (e.g. MyChart, email, phone, etc.)?
  5. Who should be contacted if there is concern about adverse reactions to the medication?
  6. How are refills best obtained and is there a notification process?
  7. If transportation problems are a barrier to medication retrieval at the pharmacy, is a mail order alternative available?

Payer

  1. Does the individual insurance plan cover a yearly screening cholesterol blood test?
    • Is there a copay?
  2. If cholesterol levels are abnormal, and the primary care provider thinks a specialist is needed, what is the referral process?
  3. Do limitations or restrictions exist relevant to seeing the recommended specialist?


Dr. Willard has no financial relationships to disclose.

References: 

  1. Griese L, Berens EM, Nowak P, Pelikan JM, Schaeffer D. Challenges in Navigating the Health Care System: Development of an Instrument Measuring Navigation Health Literacy. Int J Environ Res Public Health. 2020 Aug 8;17(16):5731. doi: 10.3390/ijerph17165731. PMID: 32784395; PMCID: PMC7460304.

Article By:

Kaye-Eileen Willard, MD, FNLA

Medical Director

Lipid Clinic and Physician Advisor

All Saints Hospital, Ascension SE Wisconsin 

Racine, WI

 

0
No votes yet