Ibbotson J1, Adhikari BL2, Adhikari B2, Ibbotson G3,4
1Samaritan's Purse Canada, Calgary, Canada, 2Sundar Dhoka Saathi Sewa, Kathmandu, Nepal, 3Green Pastures Hospital and Rehabilitation Centre, Pokhara, Nepal, 4University of Calgary, Department of Surgery, Calgary, Canada
Background: The WHO recognizes that the global burden of disease caused by disability is increasing rapidly. There are multiple barriers preventing patients in low and middle-income countries (LMICs) from accessing necessary rehabilitation care, including surgery that may prevent permanent disability. This report describes an innovative model of patient navigation in Nepal that has been effective in overcoming some of the major barriers preventing access to care for the most vulnerable groups in the country.
Purpose: Nepal faces significant challenges in caring for people with disabilities and ensuring access to appropriate surgical care required for disability prevention. The most common barriers are: lack of locally available surgical and rehabilitation care and infrastructure; socioeconomic factors; social marginalization and cultural factors; and poor medical understanding.
Methods: In 2005, a comprehensive and integrated patient navigation (PN) programme was initiated by a Nepali non-governmental organization (NGO) called SDSS. The program has several unique components which ensure a sustainable, high level of success in assisting patients from remote areas access rehabilitation and surgical care. The key components of the programme include:
1) excellent understanding amongst PN programme staff about the needs of patients accessing care for disabilities;
2) well-defined patient admission criteria wherein each patient is approved by a medical practitioner and socialworker;
3) strong relationships between programme staff and approved referring facilities;
4) strong relationships between programme staff and treatment facilities;
5) well maintained facility to lodge patients and family members while receiving care;
6) strong relationships with international donors who fund the programme since most patients are destitute and cannot pay for the medical care.
There are two streams for patients within the programme:
1) the Child Rehabilitation Project focusses on children requiring specialized rehabilitation treatment and restorative surgical interventions;
2) the Child Heart Project focusses on children requiring cardiac surgical care for congenital heart disease.
Results: Initially, there was slow and phased growth of both rehabilitation and paediatric cardiac programmes during which time the patient navigation expertise was developed, additional staff hired and referral system refined. Approximately 30 patients per year were cared for during this initial growth period. In 2013, a modern patient navigation facility was opened to house patients and family for prolonged periods of time and serve as an administrative hub. Subsequently, patient numbers increased to more than 100 patients per year. The programme continues to grow, with more referring centres requesting to send patients. The limiting factor is funding for the patient navigation service and medical care provided. More than 95% of patients coming through the programme are considered extremely vulnerable and are fully covered by external funding.
Conclusion(s): The SDSS Patient Navigation model is a comprehensive, integrated programme, which facilitates the referral of patients with complicated disabilities and congenital cardiac disease to tertiary care centres for specialized treatment. The PN service has been successful in overcoming many of the barriers preventing these families from receiving the needed rehabilitation and surgical care.
Implications: The PN procedures and lessons learned over the past 13 years of experience and growth could be applied in other LMIC settings.
Keywords: patient navigation, rehabilitation medicine, LMIC
Funding acknowledgements: Samaritan´s Purse Canada
Purpose: Nepal faces significant challenges in caring for people with disabilities and ensuring access to appropriate surgical care required for disability prevention. The most common barriers are: lack of locally available surgical and rehabilitation care and infrastructure; socioeconomic factors; social marginalization and cultural factors; and poor medical understanding.
Methods: In 2005, a comprehensive and integrated patient navigation (PN) programme was initiated by a Nepali non-governmental organization (NGO) called SDSS. The program has several unique components which ensure a sustainable, high level of success in assisting patients from remote areas access rehabilitation and surgical care. The key components of the programme include:
1) excellent understanding amongst PN programme staff about the needs of patients accessing care for disabilities;
2) well-defined patient admission criteria wherein each patient is approved by a medical practitioner and socialworker;
3) strong relationships between programme staff and approved referring facilities;
4) strong relationships between programme staff and treatment facilities;
5) well maintained facility to lodge patients and family members while receiving care;
6) strong relationships with international donors who fund the programme since most patients are destitute and cannot pay for the medical care.
There are two streams for patients within the programme:
1) the Child Rehabilitation Project focusses on children requiring specialized rehabilitation treatment and restorative surgical interventions;
2) the Child Heart Project focusses on children requiring cardiac surgical care for congenital heart disease.
Results: Initially, there was slow and phased growth of both rehabilitation and paediatric cardiac programmes during which time the patient navigation expertise was developed, additional staff hired and referral system refined. Approximately 30 patients per year were cared for during this initial growth period. In 2013, a modern patient navigation facility was opened to house patients and family for prolonged periods of time and serve as an administrative hub. Subsequently, patient numbers increased to more than 100 patients per year. The programme continues to grow, with more referring centres requesting to send patients. The limiting factor is funding for the patient navigation service and medical care provided. More than 95% of patients coming through the programme are considered extremely vulnerable and are fully covered by external funding.
Conclusion(s): The SDSS Patient Navigation model is a comprehensive, integrated programme, which facilitates the referral of patients with complicated disabilities and congenital cardiac disease to tertiary care centres for specialized treatment. The PN service has been successful in overcoming many of the barriers preventing these families from receiving the needed rehabilitation and surgical care.
Implications: The PN procedures and lessons learned over the past 13 years of experience and growth could be applied in other LMIC settings.
Keywords: patient navigation, rehabilitation medicine, LMIC
Funding acknowledgements: Samaritan´s Purse Canada
Topic: Disability & rehabilitation; Paediatrics; Service delivery/emerging roles
Ethics approval required: No
Institution: N/A
Ethics committee: N/A
Reason not required: Descriptive report
All authors, affiliations and abstracts have been published as submitted.
