At Truman Medical Center peers play a crucial role in HIV care team
History
The Peers as Partners program was established in 2000 with the aid of Ryan White Part A funding. The peer program is housed in the Infectious Disease Clinic within the Truman Medical Center, Hospital Hill, a metropolitan academic hospital that is part of a two-hospital partnership in Kansas City, MO. The Infectious Disease Clinic serves about 700 adult patients from diverse backgrounds including a large homeless population and nearby rural communities. 
Rose Farnan, RN, who supervises and coordinates the program, has been with Peer as Partners since its infancy. The mission of the program is to serve patients with the greatest need, specifically newly diagnosed patients, patients starting or changing HIV medication, or patients with comorbid conditions. The program is now funded through the Community AIDS Project through Design Industries Foundation Fighting AIDS (DIFFA) and partners with the People to People Program for training and technical assistance.
Peer Roles and Responsibilities
The Peers as Partners program currently has four paid peer educators and one volunteer. In the past year, these peer educators have served 123 patients. Peer educators are people living with HIV who help patients navigate the system. They connect patients to case management, serve as a resource and as connection to the HIV/AIDS community, and link patients to programs and services within or outside Truman Medical Center. Peer educators participate in weekly “lunch and learn” programs in which speakers from local organizations and pharmaceutical companies present HIV/AIDS and other relevant information to peers educators.
More than anything, peer educators have opened up the eyes of many of our patients who had no idea that there were so many programs and services that they could link into or attend.
“More than anything, peer educators have opened up the eyes of many of our patients who had no idea that there were so many programs and services that they could link into or attend,” remarks Farnan. Because of the hospital structure, peer educators, case managers, social workers, and providers work closely together. If patients are hospitalized, peer educators are available to provide support. “If something happens and they’re admitted, it’s very easy and convenient for a peer educator to provide that continuum for [the patients] while they’re hospitalized,” says Farnan.
Peer Training
Since 2006, peer training for Truman Medical Center has been provided through the People to People (PTP) program. Farnan expressed her delight with PTP training. “All of [the peer educators] that come in from the PTP program are so anxious to jump in there. I really appreciate the kind of energy they bring. A lot of their pride and their understanding of their accomplishments come from the PTP training.” In addition to the PTP training, peers receive onsite training and initially observe other peers prior to taking on their own case load.
Monitoring and Evaluating Peer Educators’ Work
The peer educators administer pre-and post-tests to patients that assess their health care beliefs, viral loads, engagement in care, and HIV knowledge. Tests are administered every three months and are analyzed for consistency and improvement. Farnan compares this information to the number of kept scheduled appointments, urgent care appointments, and the number of contacts with their peer educators.
Challenges
At the inception of the program, patients were recruited from the clinic, trained in-house and hired as peer educators. This resulted in a change in relationship dynamics, which both the peers and the care team needed to address.
When you’ve got providers who say ‘I need a peer educator on my afternoon schedule’ you know how successful it has been.“Our relationship with [the patient ] as a provider totally changed. Some days they are an employee and a colleague, and other days they are the patients,” explained Farnan. “There is a learning curve on both sides—the providers need to become comfortable with the peer educators before they refer patients, and the peer educators need to find their niche and establish how they interact with the providers as well. Over time, we have learned to sit down and talk about this. ” The relationship between providers and peer educators has developed to a point where the peer program is regarded as a vital and expected function within the hospital. “When you’ve got providers who say ‘I need a peer educator on my afternoon schedule’ you know how successful it has been,” said Farnan.
Another important issue which the fledgling program grappled with is establishing boundaries. “The peer educators are so inspired to help [patients] succeed—they want to be available to them 24 hours a day and help them through every obstacle,” said Farnan. “They can’t be all things to all people—they’ll burn out too quickly. We found people becoming non-adherent while they were working. They were so energetic and enthused about the program, but they let their own health care go.” Over time, a supervision structure has been put in place to address issues like these. Farnan provides supervision through biweekly one-on-one meetings in which she reviews each peer educator’s caseload as well as any challenges the peer educator may be facing. Additionally the peer educators participate in regularly scheduled staff meetings, an annual clinic-wide retreat, and a full-day retreat for peer educators.
Accomplishments
- At a recent retreat, peer educators developed the idea to offer patients peer educator services when they are triaged at Truman Medical Center. Now the peer program is incorporated into the electronic medical record as part of the triage procedure. The result: an increase in patients requesting peer support and an overall increase in awareness of the peer program.
- In response to a rising number of pregnancies in HIV positive women, the clinic developed the Positive Pregnancy Project, in which peer educators help the patient to navigate care among the obstetrical social worker, director, and perinatologist, as well as the Infectious Disease team across the street at Children’s Mercy Hospital. Recently the care team published a case study which arose from this project in the Journal of Association of Nurses in AIDS Care (JNAC) in which the peer educator role was discussed extensively.
- Truman Medical Center has developed a bilingual care team to serve the hospital’s large Latino population. The team is composed of a bilingual nurse practitioner, case manager, retention specialist, and peer educator.
- Farnan notes a shift in acceptance of the peer educator role to a point where the peer program is incorporated into the day-to-day functioning of the clinic.
- For many patients, peer educators lessen their sense of isolation and provide greater acceptance of their illness. “The more we get patients talking [with peer educators], the more comfortable they get with the notion that they have a chronic illness, not something called HIV that they have to hide away and not talk to anybody about,” said Farnan. “For many of our patients who are very isolated, the peer educators play such an important role in acceptance of their disease.”
