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Peer Support

Peer Support. Rationale – Key Characteristics Resources. Fundamental Role of Social Connections and Support. Human beings are more effective and happier when they have someone They can talk to about personal matters. Who cares about them. Who can help them when they need help.

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Peer Support

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  1. Peer Support Rationale – Key CharacteristicsResources

  2. Fundamental Role ofSocial Connections and Support • Human beings are more effective and happier when they have someone • They can talk to about personal matters. • Who cares about them. • Who can help them when they need help. • The influence of social isolation on the risk of death has been compared to the risk of death associated with well-established factors such as cigarette smoking. House, Landis & Umberson. Science, 1988 241: 540-544. Holt-Lunstad, Smith, & Layton PLOSMedicine, 2010, 7: July e1000316 www.plosmedicine.org

  3. Social Support & Chronic Disease • Social connections and support are particularly important for managing and preventing chronic diseases. • While seeing a doctor is important for prevention and support, people spend most of their time outside of a doctor’s office. • Consider the rule of 8,760…

  4. The rule of 8,760 8,766 = 24 hours X 365.25 days in a year 6 hours a year in a doctor’s office or with other health professional. 8,760 hours “on your own” to: • Maintain a healthy diet • Engage in physical activity • Monitor health status • Take medications • Manage sick days • Manage stress / cope • Arrange medical appointments and testing • Sleep

  5. Diabetes Self Management Education and Diabetes Self Management Support • Diabetes Self Management Education: • Teaches what I need to do. • “Improvements in outcomes diminish after ~ 6 months.” • Diabetes Self Management Support • Helps me plan and do what I need to do. • Support “to implement and sustain the behaviors needed to manage” diabetes. Haas, et al. (2013). National Standards for Diabetes Self-Management Education and Support. Diabetes Care 36 Suppl 1, s100-s108.

  6. Strengths of Peer Supporters • Peer supporters are not professionals. • Often have the health problem they are assisting with – e.g., people with diabetes helping others with diabetes. • Share perspectives, experience of those they help. • Have credibility regarding attitudes and capability because they are “like me.” “The doctor tells me something is important. The peer supporter helps me figure out how I feel about it whether I can do it.” • Can teach how to implement basic self management plans (e.g., healthy diet, physical activity, adherence to medications). • Peer supporters have time!!!

  7. Key Functions of Peer Support • Assistance, consultation in applying management plans in daily life • Social and Emotional Support • Linkage to clinical care • Ongoing support, extended over time Fisher et al. FamPract 2010 27 Suppl 1: i6-16.

  8. Diverse Implementation of Key Functions “Standardization by function, not content” KEY FUNCTIONS • Assist in managing diabetes in daily life • Social and emotional support • Link to clinical care • Ongoing support Local, Regional, Cultural Influences Haweet al. British Medical Journal 328:1561-1563, 2004. Aroet al. Eur J Public Health 18:548-549, 2008

  9. Example: Peer Support in San Francisco Thomas Bodenheimer and colleagues, University of California, San Francisco • Clinical Setting Six Departmentof Public Health safety-net primary care clinics serving patients covered by Medicare/Medical or SanFrancisco’s coverage foruninsured residents. • Majority of patients were non-white, ethnically and culturally diverse. • Patient Contact:83% of patients had at least 1 interaction and as many as 29 interactions with a health coach. The median number of contacts was 5, 76.6% of these were by telephone. • Outcomes at 6 months:Reduction in HbA1c by ≥ 1.0%: 49.6% in coached patients vs 31.5% of usual care patientsHbA1c < 7.5%: 22% of coached patients vs 14.9% of usual care patients Thom et al., Annals of Family Medicine 2013 11: 137-144.

  10. Community Outreach is Key Component of Patient-Centered Medical Home • However, several challenges: • Time consuming nurturing of community relationships. • Imprecise reach of community outreach: • Community programs and activities on weight management. • Attended by “vegans who run marathons.”

  11. Peer Support for Outreach/Engagement from Patient-centered Medical Homes Peer supporters were recruited from communities the effort intended to reach. • Community ties then intrinsic to services Project found that peer supporters can reliably reach those of greatest importance. Fisher et al. Arch PediatrAdolesc Med. 2009 Mar;163(3):225-32.

  12. peersforprogress.org

  13. Resources at peersforprogress.org Learn About Peer Support – What it is, evidence base, program examples:peersforprogress.org/learn-about-peer-support Promote Peer Support – Professional’s role in promotion, communicating for peer support, sharing/networking: peersforprogress.org/promote-peer-support Get Connected – Be part of the global network or peer support program leaders:peersforprogress.org/get-connected Take Action – Guides to starting, developing, and managing a program: peersforprogress.org/take-action Tools & Training – Concrete program resources including for primary care and in Spanish and Chinese: peersforprogress.org/tools-training

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