Peer Group Prescriptions: Networking as Treatment

Peer groups bring together the important elements of emotional support and practical tools for those facing unseen and unmet health needs

I'm reading through the book Rebel Health by Susannah Fox, a fantastic introduction to patient-led solutions in medical care. She describes a four-quadrant framework for the status of health needs: unseen/unmet, unseen/met, seen/unmet, and seen/met. She also describes four prototypes that help move patients towards having their needs seen and met: seekers, networkers, solvers and champions.

I was impressed particularly by her statements that peer networks have proven health benefits for patients. These peer networks also help patients move from being unseen to being seen, paving the way for developing and sharing of new solutions. In the past, there have been limited cases where I've recommended a patient or caregiver join a peer group, but it was typically for those with seen and met needs in well-established, evidence-based settings: substance use disorders (such as NA or AA) or mental health (like OA, NAMI, grief support). In residency, I participated in group visits for diabetes and chronic pain as well. Unfortunately, I have seen very few practices support those visit-types. Rarely have I extended recommendations for peer support beyond these conditions.

Then, last weekend I attended a conference and saw a dear physician friend and long-time mentor who faces a daily battle with POTS (postural orthostatic tachycardia syndrome). It was a timely discussion given that I had been reading this book. Unfortunately, POTS is in the “unseen” and “unmet” needs category. Our current health system and medical science has little to offer these patients. Like many others, her symptoms have been dismissed despite being a physician. She explained how two online groups have been the most helpful, one being a national society and the other being a Facebook group moderated by a fitness professional with the condition. She indicated positive features of this online group was the moderator and the practicality of the information. The conversations are focused and supportive. “No whining” is allowed. It was a perfect example of how peer support groups can self-regulate (particularly if there is a strong moderator), as well as how networking brings unseen, unmet needs out of the shadows. It was also a poignant reminder that what we do in healthcare transformation is not just for our patients. It is for our colleagues, our friends, and our family members.

After reading this chapter on networks and hearing from my friend, I wondered: if peer support is such a powerful tool, why am I not more routinely "prescribing" a peer support group to patients? Not all peer groups are created equally. Few are vetted or moderated by healthcare professionals. The concern of misinformation is very real, including a liability concern on the part of physicians. Despite this concern, there seem to be significant benefits if one can wade through the maze. Fox points out that misinformation is often surprisingly corrected within the groups themselves through formal group boundaries, norms and moderators. With loneliness now being described as ‘epidemic’, prescribing peer groups seems like a win-win: patients win through emotional support and helpful information, closing gaps which few physicians can fill. One might even indicated peer support as a type of social prescription, written to connect patients with a peer group in their condition. Non-profits and national societies for certain conditions are a great starting place, as they are typically large enough to have gone through peer and/or scientific vetting. After a simple internet search, I was able to find a locally grown example through the Center for Chronic Illness (https://www.thecenterforchronicillness.org/programs), containing a treasure trove of various online chronic illness groups moderated by licensed mental health professionals. I’ll be honest – I had never thought to recommend peer support beyond mental health and substance use. My horizons continue to expand!

How might a clinician write a peer group prescription? Here’s an example:

Bob Smith

Fibromyalgia Support Group

https://www.myfibroteam.com

Participate in 1 online conversation monthly for 3 months

How else could healthcare leaders and organizations facilitate peer groups as treatment?

Could we…extend our recommendations about peer groups to other diseases like COPD, heart failure, or arthritis? And make space for these groups at our facilities or in our clinic model?

Could we…get permission from our patients to connect them with another patient experiencing the same disease?

Could we…develop repositories of vetted peer support groups, and “refer” to them through our EHRs?

Could we…expand reimbursement for healthcare professionals to facilitate peer group visits for chronic conditions, including using online platforms? 

Could we include patient networkers as a support role in our clinics?

I believe the answer to many of these questions is, “Yes!” Peer support is a powerful tool in health care. Health care is a team sport. More professionals are needed to vet groups and serve as liaisons and moderators as well.  We need to think outside the exam room, particularly for those with unseen and unmet health needs.