Division of General Internal Medicine & Health Services Research, Department of Medicine, University of California Los Angeles, Los Angeles (Drs Carson, Chang, and Brown and Mss Morales, Porter, and Vassar); Los Angeles County, Department of Health Services, Los Angeles, California (Drs Hong and Behforouz and Ms Shah); Health Science Program, California State University Channel Islands, Camarillo, California (Dr Dixon); Worker Education & Resource Center, Inc, Los Angeles, California (Mss Factor and Porter); Department of Urban Public Health, Charles R Drew University of Medicine and Science, College of Science and Health, Los Angeles, California (Dr George); USC Suzanne Dworak-Peck School of Social Work, Los Angeles, California (Ms Lewis); Department of Psychological Science, University of California Irvine, Irvine, California (Ms Majeno); and Olive View-UCLA Medical Center, Sylmar, California (Ms Vassar and Dr Brown).
J Ambul Care Manage. 2022;45(1):22-35. doi: 10.1097/JAC.0000000000000405.
Medically and socially complex patients disproportionately face barriers to primary care, contributing to health inequities and higher health care costs. This study elicited perspectives on how community health workers (CHWs) act upon barriers to primary care in 5 patient (n = 25) and 3 CHW focus groups (n = 17). Participants described how CHWs acted on patient-level barriers through social support, empowerment, and linkages, and system-level barriers by enhancing care team awareness of patient circumstances, optimizing communication, and advocating for equitable treatment. Limitations existed for influencing entrenched community-level barriers. CHWs, focusing on patient preferences, motivators, and circumstances, intervened on multilevel barriers to primary care, including advocacy for equitable treatment. These mechanisms have implications for existing CHW conceptual models.
患有医学和社会复杂性疾病的患者在获得初级保健方面面临着不成比例的障碍，导致了健康不平等和更高的医疗保健成本。本研究通过 5 名患者（n=25）和 3 名社区卫生工作者（CHW）焦点小组（n=17）的研究，了解社区卫生工作者在处理初级保健障碍方面的观点。参与者描述了 CHW 如何通过社会支持、赋权和联系来处理患者层面的障碍，以及通过提高医疗团队对患者情况的认识、优化沟通和倡导公平待遇来处理系统层面的障碍。在影响根深蒂固的社区层面障碍方面存在局限性。CHW 关注患者的偏好、动机和情况，对初级保健的多层次障碍进行干预，包括倡导公平待遇。这些机制对现有的 CHW 概念模型具有重要意义。
