The Health and Recovery Peer (HARP) Program: A peer-led intervention to improve medical self-management for persons with serious mental illness
The Health and Recovery Peer (HARP) Program: A peer-led intervention to improve medical self-management for persons with serious mental illness
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DOI：
10.1016/j.schres.2010.01.026
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发表时间：
2010-05-01
影响因子：
4.5
通讯作者：
Lorig, Kate
中科院分区：
文献类型：
--
作者：
Druss, Benjamin G.;Zhao, Liping;Lorig, Kate
目的：患有严重精神疾病（SMI）的人有并发症的医疗条件的比率升高，但也可能面临挑战，在有效地管理这些conditions.Methods：研究小组开发和试点测试的健康和恢复计划（HARP），适应慢性病自我管理计划（CDSMP）的精神健康消费者。由心理健康同行领导人提供的手动六次干预，帮助参与者更有效地管理他们的慢性疾病。一项试点试验将80名患有一种或多种慢性疾病的消费者随机分为HARP计划或常规护理。在6个月的随访中，HARP项目的参与者在患者激活方面比常规护理的参与者有更大的改善（7.7%相对改善vs. 5.7%下降，组间时间相互作用p = 0.03），以及接受一次或多次初级保健访视的比率（68.4% vs. 51.9%，接受一次或多次访视，组间时间相互作用p = 0.046）。在身体健康相关生活质量（HRQOL）、体力活动、药物依从性方面观察到干预优势，尽管没有统计学显著性，但与普通医疗人群中的CDSMP具有相似的效应量。HRQOL的改善是最大的医疗和社会弱势subpopulation.Conclusions：这同行为主导的，医疗自我管理计划是可行的，并显示出改善一系列的心理健康消费者与慢性医疗合并症的健康结果的承诺。HARP干预可以为心理健康同行工作人员提供一种工具，以积极参与降低心理健康消费者发病率和死亡率的努力。(C)2010爱思唯尔有限公司版权所有。
Objectives: Persons with serious mental illnesses (SMI) have elevated rates of comorbid medical conditions, but may also face challenges in effectively managing those conditions.Methods: The study team developed and pilot-tested the Health and Recovery Program (HARP), an adaptation of the Chronic Disease Self-Management Program (CDSMP) for mental health consumers. A manualized, six-session intervention, delivered by mental health peer leaders, helps participants become more effective managers of their chronic illnesses. A pilot trial randomized 80 consumers with one or more chronic medical illness to either the HARP program or usual care.Results: At six month follow-up, participants in the HARP program had a significantly greater improvement in patient activation than those in usual care (7.7% relative improvement vs. 5.7% decline, p = 0.03 for group time interaction), and in rates of having one or more primary care visit (68.4% vs. 51.9% with one or more visit, p = 0.046 for group time interaction). Intervention advantages were observed for physical health related quality of life (HRQOL), physical activity, medication adherence, and, and though not statistically significant, had similar effect sizes as those seen for the CDSMP in general medical populations. Improvements in HRQOL were largest among medically and socially vulnerable subpopulations.Conclusions: This peer-led, medical self-management program was feasible and showed promise for improving a range of health outcomes among mental health consumers with chronic medical comorbidities. The HARP intervention may provide a vehicle for the mental health peer workforce to actively engage in efforts to reduce morbidity and mortality among mental health consumers. (C) 2010 Elsevier B.V. All rights reserved.