1 Division of Health Behavior Research, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA 2 Veterans Affairs Center for Clinical Practice Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA 3 Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA 4 Michigan Diabetes Research and Training Center, Ann Arbor, Michigan, USA.
Patient. 2009 Mar 1;2(1):5-17. doi: 10.2165/01312067-200902010-00002.
In light of the growing prevalence and healthcare costs of diabetes mellitus, it is critically important for healthcare providers to improve the efficiency and effectiveness of their diabetes care. A key element of effective disease management for diabetes is support for patient self-management. Barriers to care exist for both patients and healthcare systems. As a result, many people with diabetes do not get the care and support needed to successfully manage their diabetes.Disease management approaches that incorporate peer support may be a promising way to help provide self-management support to patients with diabetes. Trained peers provide emotional support, instrumental (tangible or material) support, education, and skills training to those they serve, and outreach and care coordination for provider systems. They play a unique role that complements and supports clinical care.To describe how peers are currently supporting diabetes care, a number of databases were searched for studies describing the roles of peers using relevant key words. This paper reviews current literature that describes the roles and duties of peers in interventions to improve diabetes care, with a focus on their contributions to six essential elements of self-management support: (i) access to regular, high-quality clinical care; (ii) an individualized approach to assessment and treatment; (iii) patient-centered collaborative goal setting; (iv) education and skills training; (v) ongoing follow-up and support; and (vi) linkages to community resources.Peers worked under a variety of titles, which did not define their duties. The scope of their work ranged from assisting health professionals to playing a central role in care. Providing education and follow-up support were the two most common roles. In all but one study, these roles were carried out during face-to-face contact, most frequently in community sites.A growing body of literature supports the value of peer models for diabetes management. Additional research can answer remaining questions related to such issues as cost effectiveness, sustainability, integration of peers into health and social service delivery systems, and recruitment, training, and support of peers. Continuing to develop and evaluate innovative models for more effectively mobilizing and integrating peers into diabetes care has great potential for improving diabetes outcomes worldwide.
鉴于糖尿病的患病率和医疗保健费用不断增加，提高医疗保健提供者的糖尿病护理效率和效果至关重要。糖尿病有效疾病管理的一个关键要素是支持患者的自我管理。患者和医疗保健系统都存在护理障碍。因此，许多糖尿病患者无法获得成功管理糖尿病所需的护理和支持。将同伴支持纳入疾病管理方法可能是帮助为糖尿病患者提供自我管理支持的一种有前途的方法。经过培训的同伴为他们所服务的人提供情感支持、工具支持（有形或物质）、教育和技能培训，以及为提供者系统提供拓展和护理协调。他们扮演着独特的角色，补充和支持临床护理。为了描述同伴如何支持当前的糖尿病护理，我们搜索了多个数据库，以查找使用相关关键词描述同伴角色的研究。本文综述了目前描述同伴在改善糖尿病护理干预措施中作用和职责的文献，重点介绍了他们对自我管理支持的六个基本要素的贡献：（i）定期获得高质量的临床护理；（ii）个性化的评估和治疗方法；（iii）以患者为中心的协作目标设定；（iv）教育和技能培训；（v）持续的随访和支持；（vi）与社区资源的联系。同伴使用各种头衔工作，但这些头衔并没有定义他们的职责。他们的工作范围从协助卫生专业人员到在护理中发挥核心作用。提供教育和随访支持是最常见的两个角色。在除一项研究之外的所有研究中，这些角色都是通过面对面接触来完成的，最常见于社区场所。越来越多的文献支持同伴模式在糖尿病管理中的价值。更多的研究可以回答与成本效益、可持续性、将同伴纳入卫生和社会服务提供系统以及招募、培训和支持同伴等相关的剩余问题。继续开发和评估将同伴更有效地动员和整合到糖尿病护理中的创新模式，对改善全球糖尿病结局具有巨大潜力。
