Canada Research Chair in Partnership with Patients and Communities, Centre de recherche du centre hospitalier de l'Université de Montréal (CRCHUM), 850 St-Denis Street, Montréal, Québec, H2X 0A9, Canada.
Public Health Agency of Canada, 200 René-Lévesque West Blvd, #102, Montréal, Québec, H2Z 1X4, Canada.
BMC Prim Care. 2024 Aug 12;25(1):298. doi: 10.1186/s12875-024-02548-5.
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.
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.
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.
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.
同伴支持在社区基层医疗的特定领域（如心理健康、药物使用、艾滋病、无家可归和土著健康）得到了广泛研究。这些项目通常基于这样一种假设，即同伴必须具有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伴融入服务于具有不同健康状况和社会背景的人群的一般基层医疗环境中。
2020 年至 2022 年期间，进行了一项参与式定性研究，以探索在加拿大蒙特利尔的基层医疗环境中整合同伴支持工作者的可行性、可接受性和预期效果。对患者、家属、临床医生和同伴支持工作者的 18 次半结构化访谈进行了主题分析。
研究结果表明，同伴通过分享自己的困难以及如何克服困难与患者建立联系，而不是分享相似的健康或社会状况。同伴在治疗轨迹之外提供社会支持和指导，并将确定的需求与社区中的可用资源联系起来，弥合了卫生和社会保健之间的差距。基层医疗临床医生从同伴支持工作中受益，因为它有助于克服治疗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、经济补偿以及在医疗保健系统中缺乏正式地位的理解，将同伴融入基层医疗团队可能具有挑战性。
我们的研究结果表明，为了建立信任关系，同伴不需要具有相似的健康或社会状况。相反，他们利用自己的经验知识、优势和能力来建立有意义的关系和可靠的联系，从而弥合卫生和社会保健之间的差距。这反过来又使患者对更美好的生活充满希望，使他们能够积极参与自己的护理，并帮助他们实现超越医疗保健的生活目标。最后，将同伴纳入基层医疗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，并帮助患者应对医疗服务的复杂性。
