Enriching Patient-Centered Medical Homes Through Peer Support

Abstract

Peer supporters are recognized by various designations-community health workers, promotores de salud, lay health advisers-and are community members who work for pay or as volunteers in association with health care systems or nonprofit community organizations and often share ethnicity, language, and socioeconomic status with the mentees that they serve. Although emerging evidence demonstrates the efficacy of peer support at the community level, the adoption and implementation of this resource into patient-centered medical homes (PCMHs) is still under development. To accelerate that integration, this article addresses three major elements of peer support interventions: the functions and features of peer support, a framework and programmatic strategies for implementation, and fiscal models that would support the sustained viability of peer support programs within PCMHs.Key functions of peer support include assistance in daily management of healthrelated behaviors, social and emotional support, linkage to clinical care, and longitudinal or ongoing support. An organizational model of innovation implementation provides a useful framework for determining how to implement and evaluate peer support programs in PCMHs. Programmatic strategies that can be useful in developing peer support programs within PCMHs include peer coaching or mentoring, group self-management training, and programs designed around the telephone and information technology. Fiscal models for peer support programs include linkages with hospital or health care systems, service-or community-based nonprofit organizations, and partnerships between health care systems and community groups. Peer support promises to enrich PCMHs by activating patients in their self-care, providing culturally sensitive outreach, and opening the way for partnerships with community-based organizations.

Contributions of Peer Support to Health, Health Care, and Prevention: Papers from Peers for Progress

“…Key findings curated by Peers for Progress and reported by papers in this supplement [35][36][37][38][39][40][41] help to guide these efforts.…”

“…Substantial evidence shows that peer support can help in this. The present paper by Daaleman and Fisher 39 seeks to "accelerate the integration" of peer support into PCMHs by addressing 3 elements: a model of peer support that stresses the 4 key functions identified by Peers for Progress, a framework and strategies for implementation, and fiscal models to sustain these approaches.…”

Integrating Community Health Workers Into Medical Homes

“…2 CHWs complement roles played by traditional health professionals through culturally sensitive outreach, patient education, resource identification, case management, care coordination, and patient support. [3][4][5][6] Interventions by CHWs supporting chronic disease self-management and preventive services show improved health care utilization, knowledge, self-care, adherence, health outcomes, and quality of life, particularly when these workers are integrated into primary care teams. 4,[7][8][9][10][11][12][13][14][15][16][17][18][19][20] Their interventions are most often directed to and studied in underserved communities (racial and ethnic minority and low-income populations, federally qualified health care [FQHC] settings), where the integration of these workers show benefit.…”

“…[24][25][26] Researchers have explored the experience of CHWs with integration into care teams and examined how health care delivery systems might be 27-31 Experts have outlined implementation barriers (fragmented and disease-specific interventions, lack of clear work protocols, high turnover, variable performance, and a history of low-quality evidence), but argue that these barriers can be overcome through established standards to ensure a skilled CHW workforce, clearly defined roles, concrete implementation strategies, and an expanded scope of reimbursable services to include their services. 5,6,25,26,32 Little research exists on whether these strategies are sufficient for wide adoption of CHWs within primary care and how clinics make decisions about this adoption.Minnesota was the first state to create and offer a statewide competency-based CHW curriculum situated in postsecondary education. 19,33 Since 2009 Minnesota Medicaid has reimbursed diagnosis-related CHW patient education and self-management services.…”

A Qualitative Study of How Health Coaches Support Patients in Making Health-Related Decisions and Behavioral Changes

“…1,2 Coaches focus on helping patients to identify goals, create plans to make changes, and implement changes. Although health coaching can be performed by licensed professionals including nurses, physical therapists and respiratory therapists, 3,4 or by other patients (peer support), [5][6][7][8] medical assistants 1,9,10 and other unlicensed health workers (eg, community health workers, lay health advisers, and promotoras) [11][12][13][14][15][16] are emerging as a common and relatively economical workforce that may meet the demand for self-management support. Health coaching has been proposed as an inexpensive and effective means to improve control of chronic conditions 1 and has been effective in improving management of diabetes and other risk factors for cardiovascular disease, asthma, and chronic obstructive pulmonary disease.…”