I co authored this article with my colleague from ACCESS Health Singapore, Denise Ong
“Patient centered care” is a term that has become ubiquitous in healthcare policy and strategy documents. Today chronic diseases such as diabetes prevail. Health and social needs of an aging population are typically complex and intertwined. Healthcare is becoming democratized. It is no wonder then that healthcare providers are compelled to consider and respect the needs and preferences of service users.
In Singapore, reforms are well underway to deliver more patient centered, integrated care. Chief among these are the reorganization of the healthcare system into Regional Health Systems and the establishment of the Agency for Integrated Care. Recognizing that prevention and management of chronic conditions needs to happen beyond the walls of medical settings, there are concerted efforts to promote healthy behaviors and self care within the community.
What is lacking from prevailing models of patient centered care are approaches that harness people’s inherent strengths and that emphasize mutual support. Those who live with chronic conditions build up expertise in how to manage their health and navigate the care system. Their lived experience is a valuable resource that could be used to enhance the experience and outcomes for others with similar health conditions.
Yet the healthcare system is still dominated by a medical model. There continues to be an over reliance on health professionals. Services are not geared towards tapping on the wealth of experience of those outside traditional health domains or those without formal qualifications. This is despite the steep challenge of growing the healthcare workforce at a rate that will meet the needs of a rapidly aging population.
For people with a chronic condition like diabetes, self management often requires making major, long term lifestyle changes. The changes in behavior and formation of new habits occur outside the slivers of time that people spend in appointments with health professionals. They occur in homes, workplaces and communities, and are deeply influenced by social milieu.
As ACCESS Health International found in a focus group study conducted in Singapore last year, older adults with chronic conditions want more personalized and sustained support. While most people can recite the importance of eating well, moving more, and complying with medication, translating this into real, lasting action within the context of their everyday lives is where the challenge lies.
What came through strongly in the focus groups was the desire to interact with peers who have similar health conditions. People want to learn with and from each other, to share experiences and tips, and to feel socially and emotionally connected. There is a recognition that peers can provide influence and support in a way that professionals and family may not.
Evidence exists for the power of peer support. The approach has been shown to improve health and psychosocial outcomes for people living with long term conditions. It builds people’s knowledge, skills and confidence to take control of their health. The reciprocal nature of peer support recognizes the value of people’s lived experience, and brings wide reaching and mutual benefits to those involved. Among these is a sense of dignity and social connectedness; outcomes that are particularly important to and valued by older people.
The approach is by no means a new one in Singapore. Alexandra Health System’s Wellness Kampungs support local residents to lead self directed activity groups that promote healthy living. Tsao Foundation has piloted and is supporting the roll out of self care training and peer monitoring for groups of older persons, as part of the Self Care on Health of Older Persons in Singapore (SCOPE) program. Singapore Association for Mental Health trains and employs Peer Support Specialists to assist people experiencing mental illness in the recovery process . However, peer support remains under valued and outside the mainstream of healthcare services.
By placing the focus on people – their experiences, perspectives, priorities, and relationships – peer support should be a fundamental component of patient centered care. By putting people with similar chronic conditions in the lead to support each other, peer support is a vital part of achieving a more sustainable healthcare system – one that is not just patient centered, but people powered.