Center for Integrated Healthcare, Syracuse VA Medical Center.
Department of Psychology, The University of Scranton.
Psychol Serv. 2019 Aug;16(3):433-444. doi: 10.1037/ser0000242. Epub 2018 Nov 8.
Peer support is increasingly recognized as consistent with the goals of integrated primary care and is being implemented in primary care settings as a patient-centered approach that increases patient activation and access to care. Within the Veterans Health Administration (VHA), peer support specialists (PSSs) have traditionally worked in specialty mental health settings and only recently started working in Primary Care-Mental Health Integration (PC-MHI) settings. Prior research has identified implementation challenges, such as role confusion, when integrating peer support into new settings. In this qualitative descriptive study, we conducted semistructured interviews on perceived barriers and facilitators to implementing peer support in PC-MHI with 25 key stakeholders (7 PSSs, 6 PSS supervisors, 6 PC-MHI providers, and 6 primary care providers). We used conventional content analysis to code responses within four a priori implementation categories: barriers, initial facilitators, long-term facilitators, and leadership support. Perceived barriers included poor program functioning, inadequate administrative support, role confusion, and negative stakeholder attitudes. Key perceived facilitators of initializing and maintaining peer support were similar; administrative support was emphasized followed by program functioning and team cohesion. Stakeholder buy-in and access/visibility were perceived to facilitate initial implementation, whereas evidence of success was believed to facilitate maintenance. Stakeholder buy-in and administrative support were considered key elements of leadership support. Results were consistent with prior research from specialty mental health settings, but identified unique considerations for PC-MHI settings, particularly clarifying the PSS role based on local PC-MHI needs, obtaining buy-in, and facilitating integration of PSSs into the primary care team. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
同伴支持越来越被认为符合综合初级保健的目标，并作为一种以患者为中心的方法在初级保健环境中实施，这种方法可以提高患者的积极性和获得护理的机会。在退伍军人健康管理局（VHA）中，同伴支持专家（PSS）传统上在专门的心理健康环境中工作，最近才开始在初级保健-心理健康综合（PC-MHI）环境中工作。先前的研究已经确定了在将同伴支持整合到新环境中时存在的实施挑战，例如角色混淆。在这项定性描述性研究中，我们与 25 名利益相关者（7 名 PSS、6 名 PSS 主管、6 名 PC-MHI 提供者和 6 名初级保健提供者）进行了关于在 PC-MHI 中实施同伴支持的感知障碍和促进因素的半结构式访谈。我们使用常规内容分析对四个预先确定的实施类别内的响应进行编码：障碍、初始促进因素、长期促进因素和领导力支持。感知障碍包括计划运作不良、行政支持不足、角色混淆和利益相关者的负面态度。最初启动和维持同伴支持的主要感知促进因素相似；行政支持是重点，其次是计划运作和团队凝聚力。利益相关者的认可和获得/可见度被认为有助于初始实施，而成功的证据被认为有助于维持。利益相关者的认可和行政支持被认为是领导力支持的关键要素。结果与来自专门的心理健康环境的先前研究一致，但为 PC-MHI 环境确定了独特的考虑因素，特别是根据当地 PC-MHI 的需求明确 PSS 的角色，获得认可，并促进 PSS 融入初级保健团队。（PsycINFO 数据库记录（c）2019 APA，保留所有权利）。
