Great @nytimes article on need for community health workers #CHWs featuring my colleague @prabhjotsinghNY... http://t.co/wShbXqQl46— Leana Wen, M.D. (@DrLeanaWen) 29 agost, 2014
Dr. Leana Wen, the chosen tweet author and author of the book "When doctors don’t listen", warns her followers that Tina Rosenberg has published an article in the New York Times about what Community Health Workers in the US do. After reading Rosenberg’s article, I thought that this tweet was not a good choice for our readers, as the American reality is a lot different from ours (in Spain). They have a much messier model and therefore they need low cost professionals who can lend a helping hand; in short, poorly paid quasi-volunteers working for charities helping the management of issues such as medication and habits of people living in poverty.
But the article does not stop there and also talks of the IMPaCT program of Penn Centre with some ideas about the Community Health Workers (CHW) that are more structured and bring very good results, as you can see in the graph on the left. And then I thought about the experience of Kaiser Permanente, an organization that has developed a model in primary care based on population segments of complexity/risk with nurses, pharmacists and assistants who perform home monitoring for people who have difficulty understanding the instructions, or who have an unhealthy lifestyle or are not in control of relevant risk factors.
I assume that you now begin to understand why I'm back to thinking that Dr. Wen’s tweet was a good choice and finally I have not rejected it. I believe that now that our primary care – is better organized than the North American one - is so concerned with the chronic complex patient, it wouldn’t hurt that the primary care nurse had the support of an auxiliary group (professional), with basic training (along the Penn Centre’s lines), to work specifically with people living in situations of social and economic fragility, but also with patients in early chronic conditions that require individualized support in understanding their illnesses.