背景:同伴支持已在基于社区的初级保健的特定领域进行了广泛研究,例如心理健康,物质使用,艾滋病毒,无家可归,土著健康。这些计划通常建立在这样的假设之上,即同龄人必须分享相似的社会身份或疾病的生活经历才能有效。然而,目前尚不清楚如何将同龄人整合到为不同健康状况和社会背景的人群提供服务的一般初级保健环境中.
方法:在2020年至2022年之间进行了一项参与式定性研究,以探索可行性,可接受性,以及在蒙特利尔的初级保健环境中整合同伴支持工作者的感知效果,加拿大。主题分析是基于对患者的半结构化访谈(n=18)进行的,亲戚,临床医生,和同行支持工作者。
结果:研究结果表明,同龄人通过分享自己的困难以及如何克服这些困难来与患者建立联系,而不是分享类似的健康或社会条件。同行提供超出护理轨迹的社会支持和指导,并将确定的需求与社区中的可用资源联系起来。弥合健康与社会保健之间的差距。初级保健临床医生受益于同伴支持工作,因为它有助于克服治疗上的障碍,并促进患者需求的沟通。然而,由于临床医生对同伴支持工作的性质和局限性的理解,将同伴纳入初级保健团队可能具有挑战性,经济补偿,以及在医疗保健系统中缺乏正式地位。
结论:我们的结果表明,要建立信任关系,同龄人不需要分享类似的健康或社会条件。相反,他们利用他们的经验知识,优势,以及建立有意义的关系和可靠联系的能力,弥合健康和社会护理之间的差距。这个,反过来,给病人灌输对美好生活的希望,使他们能够在自己的照顾中发挥积极作用,并帮助他们实现医疗保健以外的生活目标。最后,将同龄人融入初级保健有助于克服预防和护理的障碍,减少对机构的不信任,优先考虑需求,并帮助患者驾驭复杂的医疗服务。
BACKGROUND: Peer support has been extensively studied in specific areas of community-based primary care such as mental health, substance use, HIV, homelessness, and Indigenous health. These programs are often built on the assumption that peers must share similar social identities or lived experiences of disease to be effective. However, it remains unclear how peers can be integrated in general primary care setting that serves people with a diversity of health conditions and social backgrounds.
METHODS: A participatory qualitative study was conducted between 2020 and 2022 to explore the feasibility, acceptability, and perceived effects of the integration of a peer support worker in a primary care setting in Montreal, Canada. A thematic analysis was performed based on semi-structured interviews (n = 18) with patients, relatives, clinicians, and a peer support worker.
RESULTS: Findings show that peers connect with patients through sharing their own hardships and how they overcame them, rather than sharing similar health or social conditions. Peers provide social support and coaching beyond the care trajectory and link identified needs with available resources in the community, bridging the gap between health and social care. Primary care clinicians benefit from peer support work, as it helps overcome therapeutic impasses and facilitates communication of patient needs. However, integrating a peer into a primary care team can be challenging due to clinicians\' understanding of the nature and limits of peer support work, financial compensation, and the absence of a formal status within healthcare system.
CONCLUSIONS: Our results show that to establish a relationship of trust, a peer does not need to share similar health or social conditions. Instead, they leverage their experiential knowledge, strengths, and abilities to create meaningful relationships and reliable connections that bridge the gap between health and social care. This, in turn, instills patients with hope for a better life, empowers them to take an active role in their own care, and helps them achieve life goals beyond healthcare. Finally, integrating peers in primary care contributes in overcoming obstacles to prevention and care, reduce distrust of institutions, prioritize needs, and help patients navigate the complexities of healthcare services.