Finding a Way with the Wayfinder Patient Navigation Program: Addressing Chronic Disease Disparities for COFA Migrant Populations in Honolulu

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2024

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Introduction:
Historical events such as US thermonuclear weapon testing within their home lands left many Compacts of Free Association (COFA) citizens, including those of Chuukese, Marshallese, Pohnpeian, Yapese, and Kosraean descent, with poor health and educational outcomes that led to their migration to Hawai’i.

Objectives:
Perform clinic needs assessments and address disparities with a patient navigation program.

Methods:
A retrospective case-control study was conducted to quantify the severity of health disparities among COFA-affiliated populations receiving primary care in a hospital-embedded teaching clinic in Honolulu, HI by evaluating prevalence of chronic, noncommunicable diseases.
The Wayfinder Program was established to address the relative health burden. Medical students were given didactics on patient-centered communication skills, cultural humility, and COFA-specific issues. The students utilized telephone interpreter services to connect with patients and address their gaps in care.

Results:
In comparison to the age- and sex-matched control group, patients with ethnolinguistic backgrounds from COFA nations have diabetes prevalence twofold greater (54.1%), chronic kidney disease 1.8 times greater (24.3%), and history of stroke two times greater (13.0%). Prevalence of uncontrolled diabetes in the studied population was more than three times higher (16.1%), and end stage renal disease 3.9 times higher (10.2%) than that of the control group.
After finding that one of the two telephone interpreter agencies used had fewer wait times (average wait time 8 mins vs 24 mins), a clinic policy change was implemented for preference of interpreter companies.Following one year of the program, key exemplary case studies were reviewed, highlighting the benefit of the program for the migrant patient population.

Conclusion:
To address chronic disease disparities in COFA migrants, medical students work as patient navigators through the Wayfinder program and are continuing to evaluate and improve the program for this patient population.

Desired Impact:
Evaluate the relative burden of chronic, noncommunicable diseases (e.g. diabetes, chronic kidney disease) among patients with ethnolinguistic backgrounds from COFA nations within a primary care practice in Hawai’i.
Assess the importance of using interpreter services for rare languages of the Pacific in patient care delivery, while appraising differences in access between two language service agencies.
Translate a model of medical students as patient navigators to the novel context of COFA-associated patient populations in Hawai’i.

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