Relationship-based navigation helped more primary care patients access health and social services than referral to a free information service.
A randomized trial of 326 primary care patients in Canada found that comprehensive, relationship-based navigation improved access to health and social services compared with referral to a free information service. The results suggest that identifying social needs may be insufficient when patients must navigate
At 3 months, 50.3% of patients assigned to the Access to Resources in the Community (ARC) model reported accessing needed resources, compared with 35.8% assigned to 211-Ontario signposting.¹ In an accompanying editorial, Laura M. Gottlieb, MD, MPH, and colleagues wrote that “more intensive, relationship-based navigation outperforms lower-intensity approaches,” while emphasizing the importance of patient complexity, visit modality, and language concordance when designing social care programs.²
Investigators led by Simone Dahrouge, PhD, of the Bruyère Health Research Institute and University of Ottawa enrolled adults with health or social needs from
Participants assigned to ARC could meet with a bilingual navigator in person or communicate by telephone, email, or text according to their preferences. Support continued for up to 3 months and could include completing forms, arranging transportation, identifying appropriate services, and providing emotional support.
The comparator reflected a lower-intensity approach: patients were directed to contact 211-Ontario, a free multilingual telephone and online information service. The service primarily identified available resources during the initial contact, without planned longitudinal follow-up.
In addition to the higher proportion reporting resource access, ARC participants accessed more resources on average and reported greater improvement in their ability to engage in their care.¹ Within the intervention group, the likelihood of access increased with each additional in-person navigator visit.
The study also examined access among Ontario’s Francophone minority, which represents less than 5% of the provincial population. ARC used an “active offer” model under which all patients were invited to receive navigation and community services in their preferred official language.
Among Francophone participants seeking French-language services, 92% of resources accessed through ARC were language concordant, compared with 36% through 211-Ontario.¹ This difference indicates that navigation intensity may affect not only whether patients reach a service but also whether the service is appropriate to their language needs.
Social prescribing is intended to connect patients with nonmedical resources addressing food, housing, transportation, and social connection. Although such needs can influence health and care engagement, the trial evaluated successful resource access rather than downstream clinical outcomes, health care utilization, or cost-effectiveness. Consequently, the findings should not be interpreted as demonstrating improvements in morbidity or other health outcomes.
The 3-month follow-up, reliance on self-reported access, and conduct within 2 Ontario regions may also limit generalizability. Further studies will need to clarify which patients benefit most, whether remote navigation can reproduce the apparent advantage associated with in-person contact, and whether the additional staffing requirements are sustainable across health systems.
