Roles and Functions of Community Health Workers in Primary Care

Andrea L. Hartzler; Leah Tuzzio; Clarissa Hsu; Edward H. Wagner

doi:10.1370/afm.2208

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Table 1

CHW-PC Functions

Function	Definition	Examples From Included Studies
Care coordination	Provides information and assistance to patients about receiving care from institutions and providers outside of primary care	Navigates 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 coaching	Provides self-management support to patients through counseling involving collaborative goal setting, problem solving, and action planning	Helps 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 support	Provides a supportive, but non-therapeutic relationship, such as peer-based informational, emotional, or instrumental support	Advocates 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 assessment	Performs clinical assessments within or outside of clinic appointments	Performs quarterly clinical assessments of A_1C, 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 linking	Helps patients access local services using standardized resources	Requests 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 management	Assesses patients’ needs and provides personalized assistance	Explores 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 management	Provides limited medication reconciliation without making recommendations	Counsels 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 care	Provides 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-up	Monitors patients outside of office visits	Makes 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
Administration	Provides 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 education	Provides information and didactic skills training to patients with specific health needs	Makes 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 support	Helps patients understand medical advice and recommendations, including translation services	Clarifies 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

A_1c = glycosylated hemoglobin; CHW-PC = community health workers in primary care.

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Table 2

CHW-PC Roles

Study	Care coordination	Health coaching	Social support	Health assessment	Resource link	Case management	Medication management	Remote primary care	Follow-up	Administration	Targeted health education	Health literacy support	Total 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 studies	7	18	6	8	11	16	5	4	15	12	14	6	122

CHW-PC = community health workers in primary care.

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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.