As patient-centered medical homes (PCMHs) continue to gain steam, a new report reinforces the fact that the model's mission of lowering costs and improving access to care relies on the use of peer support from community health workers (CHWs).
Peers for Progress, a group composed of the American Academy of Family Physicians Foundation, the Patient-Centered Primary Care Collaborative (PCPCC) and the National Council of La Raza, produced the report following their joint conference in April, which brought together 10 model programs and other stakeholders to discuss the role peer support plays in the PCMH model.
The report defines peer support as services that include assistance in daily management and prevention, social and emotional support, and linkage to clinical care and community resources, and it uses the term CHW to refer to health coaches, navigators and other non-clinicians who aid patients.
"When you look at the research, you'll find a link between the contributions of peer support and positive health outcomes," Marci Nielsen, Ph.D, CEO of PCPCC, said in an announcement. "Peer support is a natural complement to advanced primary care and can be an important part of promoting clinic-to-community linkages, offering in-home support to patients and their families or caregivers, while at the same time reducing unnecessary and costly care."
Peer support also can boost population health management by coordinating with clinical sectors as well as housing and education, the report states. Veterans Administration participants emphasized the importance of bringing veterans into community organizations such as the YMCA, which can help "minimize stigma surrounding VA and mental health services."
Indeed, CHWs are especially well-positioned to bridge gaps in access to behavioral health services, as their roles within the community can help patients who are historically difficult to reach, according to the report. However, CHWs do need adequate training to handle mental and behavioral health issues, which they do not always receive.
Another pressing topic was whether CHWs should operate as part of a clinical care team or independently in the community. The report concludes that CHWs should be "complementary but not subordinate to clinicians," though it notes that "there is an ongoing need" to define CHWs' role.
Given the benefits and other considerations regarding peer support in the PCMH model, the report offers the following best practices for program success:
- Communicate the roles of CHWs relative to the clinical team
- Provide ongoing training, supervision and backup
- Recognize that the training and supervision needs of CHWs vary depending on the type and intensity of roles they perform
CHWs' roles also may expand as the healthcare sector seeks to connect more minority populations with palliative care services and as it serves a large population of aging baby boomers, the report states.
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