Optimizing Chronic Illness Self-Management for Individuals with Schizophrenia

描述(由申请人提供)：摘要康复在《美国精神卫生保健转型》中被引用，联邦行动议程：第一步，作为精神卫生服务提供系统的“唯一最重要的目标”。越来越多的人认识到，身体健康是更全面的恢复方法的关键组成部分。精神分裂症患者中医疗并存的比率上升是一个重大的公共卫生挑战，具有深远的服务交付、成本和质量影响。迫切需要创新和便携的干预措施，以便更有效地解决这一问题。尽管越来越多的人认识到自我管理策略在改善慢性医疗疾病的护理质量和结果方面具有巨大的前景，而且自我管理正日益成为以康复为导向的治疗重点，但对于如何扩大有效的医疗自我保健计划的使用，以帮助精神分裂症患者更积极地参与他们的健康和医疗保健管理，人们知之甚少。为了弥补这一差距，我们的R34应用程序符合PAR-06-248“从干预开发到服务：探索性研究资助(R34)”的目标，并建议开发和试点测试现有且有效的慢性医疗疾病自我管理计划的优化版本，以更好地满足成人精神分裂症患者的需求。我们的具体目标是：1.为建议的适应慢性病自我管理干预制定干预材料和手册。2.在对6-8名患者进行初步短期试验的基础上，完善材料和实施程序。3.对50名参与者实施一项仔细监测的试点试验，并在6个月后衡量其对以下主要结果的影响：a)与健康有关的自我效能和康复导向；b)医疗疾病自我管理技能；c)侧重于与保健提供者互动的社交/沟通技能；d)身心健康状况；以及f)医疗服务使用模式。其次，探索性分析将考察各种协变量对干预效果的影响，包括药物使用、神经认知、药物滥用、精神症状、相关共病的数量和严重性，以及消费者参与干预的定量和定性评级。此R34应用程序符合PAR-06-248“从干预开发到服务：探索性研究资助(R34)”的目标，并建议开发和试行现有有效的慢性医疗疾病自我管理计划的优化版本，以更好地满足成人精神分裂症患者的需求。

DESCRIPTION (provided by applicant): Abstract Recovery is cited within Transforming Mental Health Care in America, Federal Action Agenda: First Steps, as the "single most important goal" for the mental health service delivery system. Increasingly, physical wellness is being recognized as a key component of a more holistic approach to recovery. The elevated rates of medical co-morbidity among individuals with schizophrenia represent a significant public health challenge with profound service delivery, cost and quality implications. Innovative and portable interventions are sorely needed to more effectively address this problem. Despite the growing recognition that self-management strategies hold enormous promise for improving quality and outcomes of care for chronic medical illnesses, and the fact that self-management is gaining prominence as a recovery oriented treatment focus, relatively little is known about how to extend use of effective medical self-care programs to help persons with schizophrenia more actively participate in their health and medical care management. To address this gap, our R34 application meets the objectives of PAR-06-248 "From Intervention Development to Services: Exploratory Research Grants (R34)" and proposes to develop and pilot test an optimized version of an existing and effective chronic medical illness self-management program to better meet the needs adults with schizophrenia. Our specific aims are to: 1. Develop intervention materials and a manual for the proposed adapted chronic medical illness self management intervention. 2. Refine materials and implementation procedures based on a preliminary, short-term trial with 6-8 patients. 3. Implement a carefully monitored pilot trial for 50 participants and measure the effect at 6 months on the primary outcomes of: a) health related self-efficacy and recovery orientation; b) medical illness self-management skills; c) social/communication skills focusing on interactions with health care providers; d) physical and mental health status; and f) medical service use patterns. Secondary, exploratory analyses will examine the modifying effect of various covariates on the effectiveness of the intervention including medication use, neurocognition, substance abuse, psychiatric symptoms, number of and seriousness of related comorbidities, and quantitative and qualitative ratings of consumer participation in the intervention. This R34 application meets the objectives of PAR-06-248 "From Intervention Development to Services: Exploratory Research Grants (R34)" and proposes to develop and pilot test an optimized version of an existing and effective chronic medical illness self-management program to better meet the needs adults with schizophrenia.