Peers for Progress: promoting peer support for health around the world

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PURPOSE Peer health coaches offer a potential model for extending the capacity of primary care practices to provide self-management support for patients with diabetes. We conducted a randomized controlled trial to test whether clinic-based peer health coaching, compared with usual care, improves glycemic control for low-income patients who have poorly controlled diabetes. METHODWe undertook a randomized controlled trial enrolling patients from 6 public health clinics in San Francisco. Twenty-three patients with a glycated hemoglobin (HbA 1C ) level of less than 8.5%, who completed a 36-hour health coach training class, acted as peer coaches. Patients from the same clinics with HbA 1C levels of 8.0% or more were recruited and randomized to receive health coaching (n = 148) or usual care (n = 151). The primary outcome was the difference in change in HbA 1C levels at 6 months. Secondary outcomes were proportion of patients with a decrease in HbA 1C level of 1.0% or more and proportion of patients with an HbA 1C level of less than 7.5% at 6 months. Data were analyzed using a linear mixed model with and without adjustment for differences in baseline variables.RESULTS At 6 months, HbA 1C levels had decreased by 1.07% in the coached group and 0.3% in the usual care group, a difference of 0.77% in favor of coaching (P = .01, adjusted). HbA 1C levels decreased 1.0% or more in 49.6% of coached patients vs 31.5% of usual care patients (P = .001, adjusted), and levels at 6 months were less than 7.5% for 22.0% of coached vs 14.9% of usual care patients (P = .04, adjusted).CONCLUSIONS Peer health coaching signifi cantly improved diabetes control in this group of low-income primary care patients. Ann Fam Med 2013;11:137-144. doi:10.1370/afm.1443. INTRODUCTIONP rimary care faces serious challenges in the face of the growing demand for diabetes care. Primary care physicians are in short supply and need more time to care for patients with highly complex conditions whose costs are destabilizing US health care.1 Current numbers of nurse practitioners and physician assistants are not suffi cient to provide access to the increasing demand for primary care.1,2 Registered nurses and pharmacists, who are capable of managing a large proportion of patients with diabetes, are too costly for many primary care practices. The time of medical assistants is often consumed by managing patient fl ow and assisting clinicians to get through the day. 3 In sum, many primary care practices have no one available to provide the time-consuming counseling and teaching of self-management skills that have been shown to improve diabetes outcomes. 4 To address this need, several models have been developed to provide support for patient self-management from lay workers with minimal 138 PEER HE A LT H COACHING A ND G LYC EMIC CON T ROLtraining, including community health workers, lay peer educators, and peer coaches. Community health workers are from the community of the patients they assist but do not necessarily have the same disease as the patient. ...

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confidence: 99%

Impact of Peer Health Coaching on Glycemic Control in Low-Income Patients With Diabetes: A Randomized Controlled Trial

Thom

Ghorob

Hessler

et al. 2013

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302

“…Recognizing the need to build the evidence base for peer support and establish working program models, Peers for Progress awarded 14 grants in 9 countries on 6 continents in 2009. 16 In 2010, a major award from the Bristol-Myers Squibb Foundation supported, among other related activities, a demonstration of the integration of peer support into the patient-centered medical home (PCMH) in collaboration with the National Council of La Raza. Papers from these projects have documented the efficacy of peer support.…”

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confidence: 99%

Contributions of Peer Support to Health, Health Care, and Prevention: Papers from Peers for Progress

Fisher

Ayala

Ibarra

et al. 2015

Self Cite

SUBSTANTIAL evidence documents the benefits of peer support provided by community health workers, lay health advisors, promotores de salud, and others. The papers in this supplement, all supported by the Peers for Progress program of the American Academy of Family Physicians Foundation, contribute to the growing body of literature addressing the efficacy, effectiveness, feasibility, reach, sustainability, and adoption of peer support for diabetes self-management. They and additional papers supported by Peers for Progress contribute to understanding how peer support can be implemented in real world settings. Topics include examination of the peers who provide peer support, reaching the hardly reached, success factors in peer support interventions, proactive approaches, attention to emotions, peer support in behavioral health, dissemination models and their application in China, peer support in the patient-centered medical home, research challenges, and policy implications.

“…4 The study protocol and results, showing that patients who received peer coaching had a significantly greater reduction in their HbA 1c levels, are described elsewhere.…”

Section: Methodsmentioning

confidence: 99%

“…4 The study protocol and results, showing that patients who received peer coaching had a significantly greater reduction in their HbA 1c levels, are described elsewhere. 2,5 Peer coaches were lowincome English-and Spanish-speaking patients with diabetes whose HbA 1c levels were 8.5% or lower and who were recommended by staff or clinicians from the clinic at which they received their care.…”

Section: Methodsmentioning

confidence: 99%

Are Low-Income Peer Health Coaches Able to Master and Utilize Evidence-Based Health Coaching?

Goldman

Ghorob

Hessler

et al. 2015

PURPOSE A randomized controlled trial found that patients with diabetes had lower HbA 1c levels after 6 months of peer health coaching than patients who did not receive coaching. This paper explores whether the peer coaches in that trial, all low-income patients with diabetes, mastered and utilized an evidence-based health coaching training curriculum. The curriculum included 5 core features: ask-tell-ask, closing the loop, know your numbers, behavior-change action plans, and medication adherence counseling.METHODS This paper includes the results of exams administered to trainees, exit surveys performed with peer coaches who completed the study and those who dropped out, observations of peer coaches meeting with patients, and analysis of in-depth interviews with peer coaches who completed the study. RESULTSOf the 32 peer coach trainees who completed the training, 71.9% lacked a college degree; 25.0% did not graduate from high school. The 26 trainees who passed the exams attended 92.7% of training sessions compared with 80.6% for the 6 trainees who did not pass. Peer coaches who completed the study wanted to continue peer coaching work and had confidence in their abilities despite their not consistently employing the coaching techniques with their patients. Quotations describe coaches' perceptions of the training. CONCLUSIONSOf low-income patients with diabetes who completed the evidenced-based health coaching training, 81% passed written and oral exams and became effective peer health coaches, although they did not consistently use the techniques taught. INTRODUCTIONH ealth coaching is the process of engaging patients with chronic conditions in their care by increasing their knowledge, skills, and confidence to the point that they become informed, active participants in the management of their conditions. 1 Patients trained as peer health coaches can provide health coaching to other patients. A recent randomized controlled trial found that patients with poorly controlled diabetes had significantly reduced hemoglobin A 1C (HbA 1c ) levels after 6 months of peer coaching compared with patients who did not receive peer coaching.2 This paper reports on the characteristics and training experiences of these peer coaches.The peer coaches were low-income patients with diabetes who had backgrounds similar to those of the patients they coached. The process that transformed these ordinary patients into effective peer coaches was training and mentoring using the Evidence-Based Health Coaching curriculum developed by 2 of the authors (A.G. and T.B.). 3 The core features of evidence-based health coaching are described in the Methods section. This paper addresses the question, did the low-income patients with diabetes recruited to become peer coaches master and utilize the evidence-based health coaching curriculum? S37 METHODSThe peer coaches described in this paper were part of a randomized controlled trial comparing peer coaching to usual care for patients with poorly controlled diabetes, conducted in conjunction w...