Feasibility and effectiveness of an automated telehealth intervention to improve illness self-management in people with serious psychiatric and medical disorders.
Feasibility and effectiveness of an automated telehealth intervention to improve illness self-management in people with serious psychiatric and medical disorders.
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DOI：
10.1037/prj0000022
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发表时间：
2013-12
影响因子：
1.9
通讯作者：
Josephson L
中科院分区：
文献类型：
--
作者：
Pratt SI;Bartels SJ;Mueser KT;Naslund JA;Wolfe R;Pixley HS;Josephson L
需要进行有效的监测和治疗，以解决严重精神疾病患者医疗合并症发生率上升的问题。本研究考察了在护士保健管理的支持下，对患有严重精神疾病和慢性疾病的成年人进行自动远程医疗干预的可行性和潜在有效性。我们进行了一项单臂试点试验，有70名患有严重精神疾病和慢性疾病的人，他们在医学上不稳定（由治疗团队确定或定义为在过去一年内多次急诊室就诊/住院）。以可行性和可接受性为主要结果，进行了为期6个月的远程医疗干预。在基线和6个月时还收集了疾病管理自我效能、精神症状、主观健康状况、健康指标和服务使用的测量。大多数个人（n = 62; 89%）参加了至少70%的远程保健会议。参与研究与抑郁和舒张压管理自我效能的提高有关。几乎所有的参与者（n = 68; 98%）认为干预后他们对自己医疗状况的理解“好多了”或“稍微好了一些”。在糖尿病患者亚组中，空腹血糖降低，在糖尿病和重度抑郁症或双相情感障碍患者中，急诊和初级保健就诊减少。这些结果证明了由护士护理经理支持的自动化远程医疗的可行性和可接受性，以及该技术在改善这些高风险个体的精神症状和慢性健康状况的自我管理方面的潜在有效性。
Effective monitoring and treatment are needed to address the elevated rates of medical comorbidity among individuals with serious mental illnesses. This study examined the feasibility and potential effectiveness of an automated telehealth intervention, supported by nurse health-care management, among adults with serious mental illnesses and chronic medical conditions. We conducted a single-arm pilot trial with 70 individuals with serious mental illnesses and chronic medical conditions who were medically unstable (determined by treatment team or defined as multiple emergency room visits/hospitalizations within the past year). The telehealth intervention was delivered for 6 months with feasibility and acceptability as the primary outcomes. Measures of illness management self-efficacy, psychiatric symptoms, subjective health status, health indicators, and service use were also collected at baseline and at 6 months. Most individuals (n = 62; 89%) participated in at least 70% of the telehealth sessions. Participation was associated with improvements in self-efficacy for managing depression and diastolic blood pressure. Almost all participants (n = 68; 98%) rated their understanding of their medical condition as “much better” or “somewhat better” postintervention. Among a subgroup of individuals with diabetes, decreases in fasting blood glucose were achieved, and among those with diabetes and major depression or bipolar disorder there were reductions in urgent care and primary care visits. These results demonstrate the feasibility and acceptability of automated telehealth supported by a nurse care manager and the potential effectiveness of this technology in improving self-management of psychiatric symptoms and chronic health conditions among these high-risk individuals.