Savanna Carson, PhD; Arleen Brown, MD
Care Connections Program: Impact of Community Health Worker intervention on addressing patient-, institutional-, and community-level barriers to primary care in a safety net setting
BACKGROUND: Safety-net hospital systems serve as critical sites of primary care for low-income patients where many medically and socially complex patients disproportionately face barriers to accessing care. The Care Connections Program aimed to promote patient engagement in primary care by utilizing Community Health Workers (CHWs) to support patients in healthcare navigation, care coordination, and linkage to social resources. This study evaluated patient and CHW perspectives on ways CHWs influenced or reduced patient barriers to primary care.
METHODS: Participants in five patient focus groups (n=25), in English or Spanish, and four CHW focus groups (n=17) were asked about the impact of CHWs on barriers to primary care in a safety-net setting.
RESULTS: CHWs and patients described multiple CHW-mediated mechanisms to reduce or influence barriers to primary care engagement on a patient-, institutional, and community level. CHW intervention improved patient level engagement through health coaching, linkage to social resources, and patient empowerment. CHWs addressed system level barriers by optimizing visits through improved patient-provider communication, increased continuity of care, and counteracting perceived discrimination or unequal treatment through advocacy. Limitations existed for influencing entrenched community-level barriers to primary care.
CONCLUSIONS: CHWs can address multilevel barriers to primary care faced by medically and socially complex patients. These mechanisms have the potential to expand and augment existing conceptual models of CHW impact. Further work is needed to examine the relative effectiveness of these different CHW mechanisms on the individual, health system, and community barriers in primary care and understand the long-term impact on patients and health systems.