Tuesday, May 3, 2011

Partnering with community health workers for better primary care

In developing countries, most primary health care is provided not by doctors or nurses, but by community health workers who have limited or minimal medical training. In the U.S., in contrast, most primary care services are provided by physicians with extensive residency training in family medicine, internal medicine, pediatrics, and obstetrics/gynecology. Even the emerging concept of the primary care team largely remains centered around the physician and his or her office practice.

But when patients with multiple uncontrolled chronic medical conditions need intensive primary care, health services researchers are discovering that the critical role of the community health worker may be just as relevant in the U.S. as it is in the Third World. An Innovation Profile in the March issue of the journal Health Affairs describes a pilot program in Vermont where patient-centered medical homes are supported by community health teams consisting of registered nurses, behavioral counselors, and dietitians, and community health workers. These teams have reduced hospital admissions, emergency department visits, and overall costs. As the profile notes, community health workers play multiple vital roles in helping patients access and navigate the care system:

Community health workers on the team help patients fill out insurance applications, follow treatment plans, manage stress, and work toward their personal wellness or disease management goals. In some cases, community health workers accompany patients to appointments and help them find transportation or child care. ... Providers said that they felt they could respond to a range of patient needs - nonclinical as well as clinical - with the community health team's support. As [one physician] puts it, "Having access to the community health team removes the fear of asking a patient the simple open-ended question, 'So, how are things?' If the patient breaks into tears or admits that things at home are chaotic, I do not feel that I need to solve all of their social woes then and there by myself. I have a whole team to help."

As Vermont moves toward becoming the first state in the nation to enact a single-payer health system for all of its residents, its thus-far successful experiment with community health teams as primary care partners bears watching closely.