PEER SUPPORT FOR CHRONIC AND COMPLEX CONDITIONS

Literature reviewDRAFT FEB ‘11

CHRISTINE WALKER

PEER SUPPORT FOR CHRONIC AND COMPLEX CONDITIONS

Literature review funded by Integrated Care Branch Dept of Health in 2010.

Aim to identify effective models of peer support for chronic and complex conditions.

Dept interested in the role of peer support across primary and subacute settings.

Evidence base from both national and international literature: Exclusions included preventative peer support

for at risk populations, mental illness except as a co-morbidity.

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PEER SUPPORT FOR CHRONIC AND COMPLEX CONDITIONS

Search methods Two researchers conducted a search of Medline,

CINAHL, PsycInfo and Cochrane using extensive search terms.

Articles from January 1990 to July 2010 written in English which include a sample of people with one or more chronic and complex conditions, who engaged in peer support activities as part of their health management.

Initial research delivered 455 articles. All abstracts read independently by both

researchers. Due to limitations decided to limit articles to

RCTs and Systematic Reviews. Final cull produced 68 articles/reviews. 3

PEER SUPPORT FOR CHRONIC AND COMPLEX CONDITIONS

Models of peer supportProfessionally led groups

(examples)Peer-led self-management programs

(examples)Peer coaches

(examples)Community health workers

(examples)Support groups

(examples)Telephone based support

(examples)Internet and e-mail support

(examples) (Ref: Heisler 2007)4

PEER SUPPORT FOR CHRONIC AND COMPLEX CONDITIONS

Results of Lit Review

Various terms used to describe peer support e.g. mentor, peer counsellors, peer advisors, expert patient.

Peer support rarely defined in the literature and rarely a theoretical basis for undertaking research into peer support.

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PEER SUPPORT FOR CHRONIC AND COMPLEX CONDITIONS

Results contd: Articles were analysed in terms of evidence for the

following attributes Effectiveness-some RCTs demonstrated improvements in

social support, self-efficacy and reduced depression. There was little evidence for improved physical results, though some RCTs reported improved energy levels/reduced fatigue.

Effectiveness of peer support in disadvantaged popns. The evidence here was stronger. Glasier’s SR found that people were more likely to respond to peers who spoke their language. A Bangladeshi RCT found some benefit in self-efficacy. An Hispanic RCT reported effectiveness of CHWs in diabetes.

My favourite is a dance class for black women with diabetes. Only one RCT evaluated cost-effectiveness. 6

PEER SUPPORT FOR CHRONIC AND COMPLEX CONDITIONS

Results contd: Outcomes of peer support

Self-efficacy or improved well-being most often reported Expert Patient Program had short term benefits but clinical

improvements were small. Funnell argues peers are best for long term care but concedes it is

not possible to tell which aspects of the programs bring the best results.

Foster et al (2009) conclude” Lay-led self-management education programmes may lead to small, short-term improvements in participants’ self-efficacy, self-rated health, cognitive symptom management, and frequency of aerobic exercise. There is currently no evidence to suggest that such programmes improve psychological health, symptoms or health-related quality of life, or that they significantly alter healthcare use. Future research on such interventions should explore longer term outcomes, their effect on clinical measures of disease and their potential role in children and adolescents. 7

PEER SUPPORT FOR CHRONIC AND COMPLEX CONDITIONS

All SRs were critical of the research design and of RCTs. Examples: Hoey et al (2008) found that in articles on peer support

in cancer there was not enough detail of the design and delivery of programs.

Glasier et al (2006) found only six of the 17 RCTs in disadvantaged populations described their randomisation process.

Van Damm et al 2005 conducted a review of social support including peer support interventions in type 2 diabetes. They considered the RCTs they reviewed were difficult to assess; for example many of the RCTs did not employ measures of social support so it was not possible to assess the optimal amount of social support or which components of social support are the most effective. Some of the RCTs did not assess biomedical outcomes.

Lorig and her colleagues describe the training process of peers whereas most RCTs don not go into details re training.

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PEER SUPPORT FOR CHRONIC AND COMPLEX CONDITIONS

Conclusions re research design: The quality of the research designs is consistently

criticised by systematic reviewers who argue that poor design and lack of information in articles makes it difficult to evaluate or trust the results reported. Evidence of the effectiveness of the programs is lacking. It is interesting to note that most reviewers do not condemn peer support programs because of this lack of evidence of their effectiveness but instead argue for better evaluation and better research design. Few however offer advice on this, with only Perez-Escamilla arguing for longitudinal randomised controlled trials of peer support in nutrition and Hoey et al (2008) arguing for better documentation of results.

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PEER SUPPORT FOR CHRONIC AND COMPLEX CONDITIONS

Interface with the Victorian health system: Not for profits are the principal focus for all models

of peer support. Examples are MS, Cancer Council, Hep C Foundation.

Sub-acute fosters self-management programs (professionally led). Stanford program at RMH; Hospital Peer Support Program for stroke patients. May also have links to support groups which are either professionally facilitated or peer-led e.g. Pensinsula health and Rosebud Diabetes Support group.

Primary Care also runs self-management programs and may also foster relationships with support groups or have their own support groups; Knox CHS 10

PEER SUPPORT FOR CHRONIC AND COMPLEX CONDITIONS

Interface with health system contd: Innovative models exist in the community e.g.

blogs, social networking. Not for profits and community groups are more likely to adopt innovative technology before sub acute and primary care.

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PEER SUPPORT FOR CHRONIC AND COMPLEX CONDITIONS

For discussion today Do you have examples of the models of peer

support that you would like to see added?

Do you think this is a correct view of the interface between peer support and the Victorian health system?

Do any of your examples show the interface between peer support and the Victorian health system?

What do you need to make peer support work for your clients?

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