美国的社区卫生工作者角色及其不断发展的跨专业关系。

Community health worker roles and their evolving interprofessional relationships in the United States.

机构信息

Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX, USA.

Southwest Rural Health Research Center, Texas A&M University, College Station, TX, USA.

出版信息

J Interprof Care. 2022 Jul-Aug;36(4):545-551. doi: 10.1080/13561820.2021.1974362. Epub 2021 Oct 15.

Abstract

In the United States, growing attention to the cost of care, the social determinants of health, prevention, and population health, signals a refocusing of efforts on value-based care. Just as Accountable Care Organizations and alternative payment models exemplify this shift in attention, so does the increasing integration of Community Health Workers (CHWs) into the US health care system. CHWs are often referred to as "bridge figures," helping clients to navigate what are oftentimes complicated pathways to access a variety of needed services. The integration of CHWs into interprofessional care teams is a process that takes time, and can lead to conflict as traditional care models are disrupted. Through focus groups with CHWs in rural and urban areas of four states, this work identifies and describes three early stages in the evolving interprofessional relationships between CHWs and other care providers. These stages are characterized by: (1) a lack of knowledge and understanding of CHW roles, (2) conflict and competition, and (3) engagement and integration of CHWs into patient care teams. A better understanding of the evolving process of CHW integration is critical to facilitate education and training that will more quickly encourage the development and efficacy of modern models of interprofessional care that include CHWs.

摘要

在美国,人们越来越关注医疗保健的成本、健康的社会决定因素、预防和人口健康,这标志着人们将重新关注基于价值的医疗保健。正如责任医疗组织和替代支付模式是这种注意力转变的典范一样,社区卫生工作者(CHWs)越来越多地融入美国医疗保健系统也是如此。CHWs 通常被称为“桥梁人物”,帮助客户在获得各种所需服务时,经常应对复杂的途径。将 CHWs 融入多专业护理团队是一个需要时间的过程,并且可能会导致冲突,因为传统的护理模式被打乱。通过对来自四个州的农村和城市地区的 CHWs 进行焦点小组讨论,这项工作确定并描述了 CHWs 与其他护理提供者之间不断发展的多专业关系的三个早期阶段。这些阶段的特点是:(1)缺乏对 CHW 角色的了解和理解,(2)冲突和竞争,以及(3)CHWs 参与和融入患者护理团队。更好地了解 CHW 整合的发展过程对于促进教育和培训至关重要,这将更迅速地鼓励包括 CHWs 在内的现代多专业护理模式的发展和有效性。

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