Cast Adrift in the Care System?A Systematic Scoping Review of Care Navigation for Older People with Multimorbidity

The problem

The health and social care environment is being transformed by the needs of the aging population, higher levels of multimorbidity, and shifts in the care landscape, e.g., specialisation and fragmentation. Health and social care systems were not designed to appropriately support individuals with multimorbidities; evolving to cater for single diseases and acute events. There is now an urgent need to redesign care structures and delivery to ensure individuals can access the right care at the right time and in the right place. If users are unable to adequately navigate health, social and third sector care, there is likely to be an increase in expenditure (use of non-appropriate services) and reduction in patient satisfaction and well-being. Multimorbidity requires patients to seek care from different practitioners, within and beyond primary care. Little is known about how users interact with care systems, and particularly how this impacts on effective care navigation. This study aimed to scope the literature on how older people (aged 55 years and over) with multimorbidities effectively navigate the care system.

The approach

A systematic scoping review addressed the research question: ‘What evidence is available in the literature regarding care system navigation in the setting of older people with multimorbidity?' Papers were drawn from five databases and ten grey literature sources using the following inclusion criteria: literature published between 2003-2014 in English, Dutch, French or German and included key terms of navigat* AND multi*morbid*. The selection was refined through reading abstracts or full papers. Final papers were extracted into a data extraction table for analysis.

Findings

From 3,171 papers in the initial search, 367 papers were identified through reviewing title and abstract. Further in-depth review of abstracts and full texts resulted in a final 12 papers. These studies demonstrated that patients perceived they were expected to find their own way, learning from experience, rather than being able to rely on a particular service that could support them to navigate their different care needs. Where care navigation programs were in place, demonstrable benefits were shown for patients with single diseases (e.g. cancer, chronic lung disease). Although promising results were seen for those patients with multimorbidities there was a lack of implementation.

Consequences

Limited literature is available on experiences of older people with multimorbidities who face a daunting task navigating the care system. To maximise health and wellbeing, increase patient empowerment and satisfaction and limit costs due to inappropriate navigation, better systems are needed which provide patients with practical, information and social support to help them navigate the care system. There is clarity as to the type and extent of support patients perceive they need, there is little evidence around the most effective method of delivering such support.

Credits

• Jolien Vos, University College Cork, Cork, Ireland
• Karen Windle, University College Cork, Cork, Ireland
• Niroshan Siriwardena, University College Cork, Cork, Ireland
• Conor Linehan