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）的人面临较高的医疗共病率，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，使重度精神障碍患者能够更有效地管理其慢性疾病。在一般人群中，以同伴为主导的疾病自我管理干预措施已被证明是可行、有效、可扩展的，并可导致自我管理和健康结果的可持续改善。在NIMH的R34干预发展拨款的资助下，研究小组开发并试行了一个修改版本，该版本是最广泛测试和使用的同伴领导的自我管理计划，慢性病自我管理计划（CDSMP），用于患有严重精神疾病的人。该干预措施的两个试点测试，即健康与康复同伴（HARP）计划，表明该计划可以在高参与度、高保留率和高计划保真度的情况下实施，并且可以在一系列结果中产生与一般医疗人群相当或更大的效果。本申请建议对HARP计划进行一次全功率、多地点的试验。总共有400名患有严重精神疾病和一种或多种慢性疾病的人将从亚特兰大都会区的四个不同的社区精神健康诊所招募，并随机分配到HARP计划或常规护理中。对于参加HARP项目的个人，两名患有重度精神障碍和一种或多种慢性疾病的同伴教育者将领导为期六周的人工干预，帮助参与者更有效地管理他们的慢性疾病。随访访谈和3个月、6个月和1年的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措施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项目参与者领导HARP小组。如果成功，这项研究将建立第一个完全以同伴为主导、以证据为基础的干预措施，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. PUBLIC HEALTH RELEVANCE: The HARP intervention has the potential to change the paradigm for improving health and health care in persons with SMI, shifting from a professionally-driven approach to one that actively engages consumers in their care. The ability to build on the national CDSMP dissemination infrastructure, growing mental health peer workforce, and the widespread reimbursement of peer services by Medicaid will help ensure uptake if the intervention proves successful.