Table 3. Themes of actions performed by the navigators in response to issues raised by patients.

Themes of Actions Performed by the Navigators	Percent of patients for whom actions were performed (N = 107)	Example of issue raised by patient	Navigator action performed in response
Facilitation of patient-doctor communication	38.3	Patient 1 had an ultrasound that she was very concerned about and wanted to speak with her physician about the results but had not heard back.	Navigator communicated this to the patient’s rheumatologist who then contacted the patient.
		Patient 48 was concerned about memory issues and wanted to see a neurologist. However, she had missed prior appointments and was told she could no longer reschedule.	Navigator reached out to the neurology department without success and then contacted the patient’s rheumatologist who was able to facilitate an appointment.
		Patient 27 was prescribed a medication for pain but felt that it made her extremely tired	Navigator spoke with the patient’s rheumatologist who sent in a lower dose of the pain medication for her to try instead.
Medication and diagnosis education	27.1	Patient 70 was concerned about retinal toxicity with hydroxychloroquine.	Navigator explained that this was rare, particularly in the first years of use, but that she needed to continue with annual eye exams to ensure that she was screened.
		Patient 28 felt like she was never educated on long-term effects or side effects of sulfasalazine and therefore she did not want to take this medication.	Navigator provided information sheets in Spanish about sulfasalazine to the patient.
Development of individualized strategies to improve adherence	15.9	Patient 2 did not want to keep her pills out because she did not want others to know about her illness and carried her medications in her purse. She tried alarm reminders but felt they did not work and that they were annoying. She was interested in a different strategy.	Navigator sent text messages to remind the patient to take her medications.
Assistance with financial/insurance issues	15.0	Patient 76 received bills for thousands of dollars for laboratory tests and appointments with her rheumatologist. She began receiving calls from a collection agency to pay her bills.	Navigator called the patient’s insurance company, the hospital billing department and the collection agency and discovered a billing error and resolved the issue.
Care coordination	15.0	Patient 71 had been followed by rheumatology, orthopedics and podiatry and recently had foot surgery. She had been unable to obtain the boot that she needed in order to walk. She had missed multiple appointments in part because of this. She had not been able to successfully communicate with any of her providers, with the medical supply store or with her insurance.	Navigator contacted insurance company, medical supply company, podiatrist and orthopedist, got all of the necessary referrals, prior authorizations and prescriptions sent appropriately and was able to get the patient the necessary boot and shoe inserts that she needed.
Social and emotional support	12.1	Patient 57 described having multiple tests to understand the etiology of her shortness of breath and all were normal. She felt very frustrated with her care and did not want to talk to physicians for a while.	Navigator provided regular calls to the patient and encouragement to have her continue to see and speak with her doctors. The patient did not want the navigator to communicate with her doctors on her behalf and therefore the navigator did not do this, but regularly called the patient to listen to her concerns.
Social work and psychiatry referrals	8.4	Patient 63 described feeling discouraged and depressed about her illness and her medications.	Navigator communicated this to the patient’s primary rheumatologist to help facilitate a referral to a therapist. Navigator also investigated local support groups and provided the patient with this information.