Research ArticleOriginal Research

Roles and Functions of Community Health Workers in Primary Care

Andrea L. Hartzler, Leah Tuzzio, Clarissa Hsu and Edward H. Wagner
The Annals of Family Medicine May 2018, 16 (3) 240-245; DOI: https://doi.org/10.1370/afm.2208

Article Figures & Data

Tables

  • Table 1

    CHW-PC Functions

    FunctionDefinitionExamples From Included Studies
    Care coordinationProvides information and assistance to patients about receiving care from institutions and providers outside of primary careNavigates individuals at risk for coronary heart disease by making medical referrals to local clinics and health care providers23
    Meets with patients following each clinic appointment to help direct them to the laboratory or to other appointments20
    Health coachingProvides self-management support to patients through counseling involving collaborative goal setting, problem solving, and action planningHelps patients design action plans to achieve goals chosen by the patient47
    Contacts patients, educating them about smoking cessation resources, motivating them using motivational interviewing techniques, and helping them decide which treatment to pursue46
    Providing social supportProvides a supportive, but non-therapeutic relationship, such as peer-based informational, emotional, or instrumental supportAdvocates on behalf of patients by serving as “culture brokers”50
    Provides emotional support, validates patients’ feelings, asks open-ended questions, and listens reflectively39
    Leads walking club and assists with group peer support meetings focused on coping with life with chronic disease, stress management, group empowerment, and other group-selected activities38
    Health assessmentPerforms clinical assessments within or outside of clinic appointmentsPerforms quarterly clinical assessments of A1C, blood pressure, weight, and foot condition (eg, visual and monofilament assessment)33
    Interviews individuals about their health concerns, including survival and social concerns such as parental stress, nutrition, access to medical care, crime, domestic violence, mental health, and substance abuse29
    Resource linkingHelps patients access local services using standardized resourcesRequests community-based services for transition from hospital discharge, such as transportation, Meals on Wheels, and in-home supports (eg, home health aid)21
    Provides links to supportive community resources and tracks referrals made to local programs to address patient-identified community and policy issues affecting disease management32
    Case managementAssesses patients’ needs and provides personalized assistanceExplores each patient’s specific barriers to receiving care and develops and implements an individualized plan to address these barriers, such as scheduling appointments, resolving insurance, accompanying patients to follow-up appointments, and making home visits42
    Identifies, trouble shoots, and responds to patients’ post-discharge concerns, such as reminders and transportation assistance for upcoming appointments, barriers to obtaining medications, concerns that might require nurse intervention, and poor understanding of self-management instructions21
    Medication managementProvides limited medication reconciliation without making recommendationsCounsels patients on medication adherence, uses physician-approved protocols to assist patients in home titration of antihypertensive medication, and notifies physician to fax prescription to the pharmacy25
    Assists with pharmacy activities, including helping patients obtain medication refills for chronic health problems24
    Remote primary careProvides limited primary care services in remote areas (eg, first aid, simple chronic disease care, follow-up care)Provides emergency care, routine clinical services, laboratory screenings, physical examinations, preventive health assessments and follow-up on call 24 hours a day28
    Provides all primary care in their community in consultation with a remote physician who calls regularly to elicit descriptions of patient signs and symptoms and to provide specific instructions for care31
    Follow-upMonitors patients outside of office visitsMakes weekly telephone calls to patients to discuss overall well-being, adherence to action plans, and blood pressure values25
    Tracks patients overdue for colorectal cancer screening by calling or meeting patients in the health center44
    AdministrationProvides front desk reception (eg, data entry)Updates patients’ medical records with colorectal cancer screening results44
    Assists in appointment scheduling, responding to patients concerns and updates contact info21
    Targeted health educationProvides information and didactic skills training to patients with specific health needsMakes home visits to deliver curriculum with hands-on activities focused on type 2 diabetes, its complications, nutrition, physical activity, blood glucose self-monitoring, adherence to medications and medical appointments, and mental health41
    Educates patients about diabetes and the importance of blood glucose control, medication adherence, diet, and exercise33
    Health literacy supportHelps patients understand medical advice and recommendations, including translation servicesClarifies questions stemming from patients’ encounters with health care providers, acts as an interpreter to enhance communication between patients and providers, reinforces teaching provided by health care providers49
    Assists patients in reading medical forms to address limited functional literacy50

    • A1c = glycosylated hemoglobin; CHW-PC = community health workers in primary care.

  • Table 2

    CHW-PC Roles

    StudyCare coordinationHealth coachingSocial supportHealth assessmentResource linkCase managementMedication managementRemote primary careFollow-upAdministrationTargeted health educationHealth literacy supportTotal number of functions
    Cluster 1: Clinical services (n = 11)
    Burns et al,21 2014✓✓✓✓✓5
    Findley et al,22 2014✓✓✓3
    Krantz et al,23,53 2013✓✓✓✓4
    Golnick et al,24 2012✓✓✓✓✓5
    Margolius et al,25,55 2012✓✓2
    Battaglia et al,26 2012✓✓✓✓4
    Naar-King et al,27 2009✓1
    Sherer et al,28,56 1994✓1
    Swider et al,29 1990✓✓2
    Deuschle et al,30 1983✓1
    Hudson et al,31 1973✓✓2
    Cluster 2: Community resource connections (n = 8)
    Wennerstrom et al,32 2015✓✓✓3
    Collinsworth et al,33,34 2013;2014✓✓✓✓✓✓✓✓8
    Volkmann et al,35 2011✓✓✓✓✓✓✓7
    Waitzkin et al,36 2011✓✓✓✓✓5
    Holtrop et al,37 2008✓✓✓✓✓✓6
    Thompson et al,38 2007✓✓✓✓✓✓6
    Adelman et al,39 2005✓✓✓✓4
    Torrey et al,40,54 1973✓✓✓✓✓✓6
    Cluster 3: Health education and coaching (n = 11)
    Perez-Escamilla et al,41 2015✓✓2
    Percac-Lima et al,42 2015✓✓✓✓✓5
    Matiz et al,43 2014✓✓✓3
    Percac-Lima et al,44,51 2014✓✓✓✓✓5
    Kangovi et al,45 2014✓✓✓✓4
    Lasser et al,46 2013✓✓✓✓4
    Thom et al,47,52 2013✓✓✓✓4
    Adair et al,20 2012✓✓✓✓✓5
    Otero-Sabogal et al,48 2010✓✓✓✓✓5
    McElmurry et al,49 2009✓✓✓✓✓5
    Poland et al,50 1991✓✓✓✓✓5
    Total number of studies718681116541512146122

    • CHW-PC = community health workers in primary care.

Additional Files

  • Supplemental Appendixes

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  • The Article in Brief

    Roles and Functions of Community Health Workers in Primary Care

    Andrea L. Hartzler , and colleagues

    Background Community health workers have the potential to enhance primary care access and quality, but they remain underutilized.

    What This Study Found An analysis of existing research finds that community health worker functions include care coordination, health coaching, social support, health assessment, resource linking, case management, medication management, remote care, follow-up, administration, targeted health education, and health literacy support. A cost-effective workforce that includes primary care community health workers could help overburdened care teams.

    Implications

    • The authors suggest that decisions about how to best utilize community health workers be based on needs of patients and care teams, clinical workflow, and financial viability.
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