Table 1 List of barriers and example of how they might be addressed by a CKD patient navigator

Assessment

First meeting with the patient; assess areas the patient is interested in working on, determine best mode of future communication, and set up the next meeting

Compliance/Adherence

Patient reports problems obtaining medications due to costs; discuss with patient to find out if there are lower cost medications through their formulary or determine if there are pharmaceutical patient assistance programs the patient might qualify for and assists with obtaining any necessary applications.

Consultation for

Patient recommended to see a specialist but hasn’t made the appointment; patient navigator helps to facilitate appointment by contacting speciality department and coordinating appointment that is right for them based on their location needs or other factor.

Education of patient/family

Edudate patients and/or their family members who do not have knowledge about CKD with resources available to them from NKF, NKDEP, National Diabetes Foundation, and Cleveland Clinic’s patient and family health education center.

Financial applications

Patient reports difficulty with utility bills; patient navigator helps contact appropriate agencies for assistance.

Information

Help them get the basic information needed to navigate the Cleveland Clinic’s large health system. This could include directions, parking information, making sure they have contact numbers for their physicians.

Insurance inquiry

Patient reports billing issues; patient navigator helps coordinate communicates with billing department about available options the patient qualifies for to obtain assistance with bills.

Refer to CCF financial counselors

Patient reports having no health insurance; referral to our financial counselors who helps determine what available health programs the patient qualifies for to obtain health insurance and or assistance.

Other CCF referral

Assists patients with how to acquire medical equipment (e.g.. continuous positive airway pressure machine and mask) that was prescibed to them for sleep apnea.

Community resources

Patient is elderly, lives alone, and would like to remain independent; identify community resources for that senior in his/her city, for example, housing that has both independent and assistance living options if patient needs it at a later date and community exercise programs that offer free to low-cost exercise classes and programs.

Transportation

Patient reports he or she is having transportation issues getting to appointments; patient navigator assists with completion of local public transportation application and coordinates with medical provider for signature approval.