Patient navigators improve CKD outcomes, more research needed
Use of patient navigators in chronic kidney disease and kidney failure correlate with improved outcomes in some settings and patient populations, according to data published in Kidney Medicine.
However, due to heterogeneity in the design and implementation of navigator models, researchers emphasized the need for more research.
“One of the pain points in advanced CKD management is the optimal transitions of late-stage non-dialysis CKD care to one of preemptive transplantation, a home modality, facility-based hemodialysis or conservative care. This process is not optimally managed in many jurisdictions as evidenced by low uptake of preemptive transplants, home modalities and the number of ‘crash’ or unplanned starts through emergency departments,” Paul Komenda MD, MHA, from the Chronic Disease Innovation Center in Winnipeg, Canada, and member of Nephrology News & Issues Editorial Advisory Board, told Healio. “To meet targets of the Advancing American Kidney Health Initiative (AAKHI) for home modalities and transplant, we must be better, and a number of startups are now trying to fill that void with specialized navigator roles. We wanted to review the evidence for these navigator-type models to gauge the quality of research into this intervention [that] exists.”
In a systematic review, researchers created a search strategy for randomized controlled trials and observational studies that measured the impact of patient navigators on patients with CKD or kidney disease.
Researchers examined 3,371 citations that included patients with CKD or kidney failure, focusing on studies that compared patient navigators to a control without limits on size, duration, setting or language. All studies from database inception to Jan. 15, 2021, were considered. Two reviewers screened the articles to find what met inclusion criteria, and identified 17 articles, including 14 original studies.
“Not surprisingly, there are a paucity of high-quality trials in this area. Most did not look at home hemodialysis uptake as an outcome as CKD clinic direct to home hemodialysis has not been a common pathway that patients have traditionally taken,” Komenda told Healio. “It was encouraging to see signals of improved transplant listing and peritoneal dialysis uptake, although the literature was of overall lower quality.”
Studies revealed that navigators came from several health care backgrounds, including nursing (n=6), social work (n=2), medical interpreter (n=1), research (n=1), kidney transplant recipients (n=2) and non-medical individuals (n=2). Researchers found that navigators focused mostly on education (n=9) and support (n=6).
Regarding kidney care, navigators were used for patients with CKD (n=5), peritoneal dialysis (n=2), in-center hemodialysis (n=4) and kidney transplantation (n=2) but not home hemodialysis.
Overall, patient navigators improved transplant workup and listing, PD utilization and patient knowledge. However, there is heterogeneity in training, focus and interactions with patients and or caregivers, so researchers noted the results of this review are at a high risk of bias.
“Next steps will include more rigorous and methodologically sound trials in the area of remote patient monitoring and navigators and looking at outcomes in alignment with AAKHI, such as home modality and transplant uptake, when a standardized intervention is taken on. Cost-effectiveness studies generating willingness-to-pay thresholds for payers will be essential in uptake of these models of care, which should be of tremendous value in negotiating with accountable care organizations.”
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