A Peer-Led, Medical Disease Self-Management Program for Mental Health Consumers

描述(由申请人提供)：患有严重精神疾病(SMI)的人面临更高的医疗合并症比率，并且在有效管理这些健康问题方面也面临挑战。迫切需要制定自我管理战略，使SMI患者能够更有效地管理他们的慢性病。在一般人群中，同行领导的疾病自我管理干预已被证明是可行的、有效的、可推广的，并导致自我管理和健康结果的可持续改善。在来自NIMH的R34干预开发赠款的资助下，研究团队为严重精神疾病患者开发和试行了最广泛测试和使用的同行主导的自我管理计划-慢性病自我管理计划(CDSMP)的修订版。这一干预措施的两个试点测试，即健康和恢复同行(HARP)计划，表明该计划可以以高参与度、保留率和计划保真度实施，并可以在一系列结果中产生与普通医疗人群相当或更大的效果大小。该应用程序建议对HARP计划进行全功能、多站点试验。共有400名患有严重精神疾病和一种或多种慢性疾病的患者将从亚特兰大大都市区的四家不同的社区精神卫生诊所招募，并随机参加HARP计划或常规护理。对于HARP计划中的个人，两名患有SMI和一种或多种慢性病的同伴教育者将领导一项为期六个疗程、为期六周的手动干预，帮助参与者成为更有效的慢性病管理者。3个月、6个月和1年的后续访谈和图表审查将评估临床结果的变化、疾病自我管理的一般和特定疾病衡量标准的改善以及护理质量。在研究的最后阶段，建立在CDSMP培训基础设施上的传播战略将允许方案参与者领导HARP小组。如果成功，这项研究将建立第一个完全由同行领导的、基于证据的干预措施，以改善这一弱势群体的身体自我管理。

DESCRIPTION (provided by applicant): Persons with serious mental illnesses (SMI) face elevated rates of medical comorbidity, and also challenges in effectively managing these health problems. There is an urgent need to develop self-management strategies that allow persons with SMI to more effectively manage their chronic medical illnesses. In general populations, peer-led disease self-management interventions have been demonstrated to be feasible, effective, scalable, and to lead to sustainable improvements in self-management and health outcomes. With funding from an R34 intervention development grant from NIMH, the study team has developed and piloted a modified version of the most widely tested and used peer-led self management program, the Chronic Disease Self- Management Program (CDSMP), for persons with serious mental illness. Two pilot tests of this intervention, the Health and Recovery Peer (HARP) program, demonstrated that the program can be implemented with high engagement, retention, and program fidelity, and can result in effect sizes across a range of outcomes comparable to or greater than those seen in general medical populations. This application proposes to conduct a fully-powered, multisite trial of the HARP program. A total of 400 individuals with serious mental illnesses and one or more chronic medical condition will be recruited from four diverse community mental health clinics in the Atlanta metro region and randomized to the HARP program or usual care. For individuals in the HARP program, two peer educators with SMI and one or more chronic medical condition will lead a six- session, six-week manualized intervention, which helps participants become more effective managers of their chronic illnesses. Follow-up interviews and chart reviews at 3 months, 6 months and one year will assess changes in clinical outcomes, improvement in generic and disease-specific measures of illness self-management, and quality of care. During the final phase of the study, a dissemination strategy building on the CDSMP training infrastructure will allow program participants to lead HARP groups. If successful, this study will establish the first fully peer-led, evidence-based intervention for improving physical self-management in this vulnerable population.