Brief Motivational Interviewing to Improve Diabetes Self-Care in Schizophrenia

简短的动机访谈以改善精神分裂症患者的糖尿病自我护理

• 批准号: 7890363
• 负责人: Lydia Ann Chwastiak
• 金额: $ 18.04万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-07-01 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7890363
• 关键词: Accounting; Address; Adherence; Area; Award; Behavior; Behavior Therapy; Blood Glucose; Blood Pressure; Body Weight decreased; Cardiovascular Diseases; Cardiovascular system; Caring; Cessation of life; Chronic; Clinic; Communities; Community Mental Health Centers; Comorbidity; Complex; Data; Data Set; Development; Development Plans; Diabetes Mellitus; Education; Enrollment; Epidemiology; Event; General Population; Glucose; Goals; Health Services; Health Services Research; Health Surveys; Healthcare; Intervention; Knowledge; Link; Lipids; Manuscripts; Measures; Mediating; Mediator of activation protein; Medical; Mental Health; Mental disorders; Mentored Patient-Oriented Research Career Development Award; Mentors; Modeling; Monitor; Morbidity - disease rate; Motivation; Myocardial Infarction; Non-Insulin-Dependent Diabetes Mellitus; Nurses; Outcome; Outcome Measure; Outcome Study; Patient Care; Patients; Performance; Persons; Pharmaceutical Preparations; Pharmacy facility; Phase; Pilot Projects; Primary Health Care; Process; Psychotherapy; Randomized; Randomized Controlled Trials; Records; Relative (related person); Research; Research Design; Research Personnel; Research Project Grants; Risk; Sample Size; Sampling; Schizophrenia; Self Care; Services; Site; Staging; Stroke; Surveys; Testing; Time; Tobacco use; Training; Treatment Efficacy; Veterans; Vulnerable Populations; base; behavior change; blood pressure regulation; career development; clinical practice; design; diet and exercise; efficacy trial; glycemic control; improved; indexing; innovation; medication compliance; mortality; motivational enhancement therapy; patient oriented; patient population; primary outcome; reduce tobacco use; research and development; response; satisfaction; secondary outcome; severe mental illness; skills; therapy design; therapy development

DESCRIPTION (provided by applicant): There is a tremendous burden of type 2 diabetes mellitus and cardiovascular disease among persons with schizophrenia. Patients with schizophrenia have a cardiovascular mortality rate that is two to three times higher than that of the general population. There have been no studies to date of interventions which improve diabetes outcomes in this vulnerable population. This application is a request for a Mentored Patient-Oriented Research Career Development Award (K23) to prepare Dr. Lydia Chwastiak to become an independent investigator in the area of management of chronic medical illness in patients with serious mental illness. She will achieve this goal through directed coursework, mentoring from accomplished researchers, involvement with two focused research projects and submission of scholarly manuscripts. Specifically, she will receive training in the design and implementation of behavioral interventions to improve chronic medical illness management and outcomes among patients with schizophrenia. The proposed research involves two projects. In this first two years of the award, Dr. Chwastiak will conduct secondary analyses of large datasets in order to inform the development of an intervention to improve diabetes self- care among patients with schizophrenia and type 2 diabetes. These analyses will utilize data from the 1999 Large Health Survey of Veteran Enrollees, the largest and most detailed survey of veterans using VA health services. The primary aim of the study is to demonstrate how poor self-care mediates poor cardiovascular outcomes in patients with schizophrenia and diabetes. The second study is a stage 1 psychotherapy development project, which will develop a community mental health center-based Brief Motivational Interviewing (BMI) intervention that aims to improve diabetes self-care among patients with schizophrenia and type 2 diabetes. This second project will be conducted in two phases over years 2-5 of the award. In phase 1, the BMI Intervention will be developed and manualized. In phase 2, we will evaluate the efficacy of the intervention through a randomized controlled pilot study in which 60 subjects with schizophrenia and type 2 diabetes are assigned to either BMI or brief education sessions. The primary measures of efficacy of BMI, relative to brief education sessions, will be the overall level of self-care and the level of self-care across five domains (diet, exercise, medication adherence, monitoring of blood glucose, and tobacco use). These behaviors will be assessed using a validated measure of diabetes self-care behaviors from the Diabetes Quality Improvement Project. Secondary process and outcome measures will include glycemic control, blood pressure control, lipid control, utilization of diabetes-related services, and knowledge of diabetes. The career development plan is a carefully staged approach to provide Dr. Chwastiak with the skills and data necessary to develop an R01 and become an independent investigator by the end of the award.

描述（由申请人提供）：精神分裂症患者中有2型糖尿病和心血管疾病的巨大负担。精神分裂症患者的心血管死亡率比普通人群高两到三倍。迄今为止，尚无干预措施的研究，可以改善这种脆弱人群的糖尿病结局。该申请是为受过指导的注重患者研究职业发展奖（K23）的要求，以准备Lydia Chwastiak博士成为严重精神疾病患者慢性医学疾病管理领域的独立研究者。她将通过有指导的课程工作，有成就的研究人员指导，参与两个重点研究项目以及提交学术手稿的指导实现这一目标。具体来说，她将接受有关行为干预措施的设计和实施培训，以改善精神分裂症患者的慢性医学疾病管理和结果。拟议的研究涉及两个项目。在该奖项的前两年中，Chwastiak博士将对大型数据集进行次要分析，以告知开发干预措施，以改善精神分裂症患者和2型糖尿病患者的糖尿病自我护理。这些分析将利用1999年对资深参与者的大型健康调查，这是使用VA卫生服务对退伍军人的最大，最详细的调查。该研究的主要目的是证明精神分裂症和糖尿病患者的自我护理如何介导较差的心血管结局。第二项研究是一项第一阶段的心理治疗发展项目，该项目将开发社区心理健康中心的简短动机访谈（BMI）干预措施，旨在改善精神分裂症患者和2型糖尿病患者的糖尿病自我护理。第二个项目将在奖项的2 - 5年内分为两个阶段。在第1阶段，将开发和手动进行BMI干预。在第2阶段，我们将通过一项随机对照试验研究评估干预措施的功效，该研究将60名精神分裂症和2型糖尿病的受试者分配给BMI或简短的教育课程。相对于简短的教育课程，BMI疗效的主要措施将是五个领域的自我保健和自我保健水平（饮食，运动，药物依从性，对血糖的监测和烟草使用）。这些行为将使用糖尿病质量改善项目的糖尿病自我护理行为的验证措施进行评估。次要过程和结果指标将包括血糖控制，血压控制，脂质控制，与糖尿病相关服务的利用以及糖尿病知识。职业发展计划是一种精心策划的方法，可为Chwastiak博士提供开发R01所需的技能和数据，并在奖励结束时成为独立的研究者。