Olivia Ishibashi, MD, MPP; Heather Schickedanz, MD
Patient and Provider Voices in the Geriatrics Community Resources Navigator eConsult Program in the Los Angeles Health Care Safety-Net
Background: Health systems must optimize access to community resources to address a diverse urban aging population's complex needs. Since 2018, providers in the Los Angeles County Department of Health Services have used the Geriatrics Navigator Program (Geri eConsult) for telephonic navigation of geolocated, culturally appropriate, low-cost community resources for older patients and caregivers. To improve utilization and linkage to resources with the Geri eConsult program, feedback from stakeholders can ensure the service meets the needs of vulnerable older adults as intended.
Methods: Our retrospective qualitative cohort study collected feedback from 1) participating patients, through telephonic interviews, and 2) participating providers, through online surveys, regarding their experience with the Geri eConsult. By convenience sampling, focus groups explored perceived strengths and barriers of the service with 3) providers new to the Geri eConsult service, and 4) social workers as potential Navigators.
Results: 15 patients (87% ≥ 80 years old, 73% female, 73% Spanish-speaking), 16 providers, and 8 social workers were interviewed across multiple sites. All (100%) participating patients reported that they would receive the service again despite a 53% linkage rate. While 38% of participating providers reported that the program was easy to use, all emphasized it was useful in caring for older adult patients. Focus groups of program-naive providers and social workers revealed perceived strengths of enhanced patient care and integration into the electronic health record from the online portal. Barriers included concerns regarding resource and personnel capacity, and in integrating the program into existing clinic workflows.
Conclusions: Patient and provider participants were satisfied with the program and felt it was useful. Program-naive stakeholders identified concerns regarding workflow integration and sustainability. These results may help expand the program to new clinical sites with improved workflows and Navigator support. In the era of COVID-19, user-friendly virtual linkage programs for community resources may support innovative, patient-centered, and coordinated geriatrics care to better address the social determinants of health in underserved older adult populations.