Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30316, United States.
Schizophr Res. 2010 May;118(1-3):264-70. doi: 10.1016/j.schres.2010.01.026. Epub 2010 Feb 25.
Persons with serious mental illnesses (SMI) have elevated rates of comorbid medical conditions, but may also face challenges in effectively managing those conditions.
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.
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.
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.
患有严重精神疾病（SMI）的人患有合并症的医疗条件的比率较高，但也可能在有效管理这些疾病方面面临挑战。
研究小组开发并试点了健康与康复计划（HARP），这是慢性病自我管理计划（CDSMP）的精神健康消费者适应版。一个由心理健康同行领袖提供的、有指导手册的、六节的干预措施，可以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配到 HARP 计划或常规护理中。
在六个月的随访中，HARP 计划的参与者在患者激活方面的改善明显大于常规护理组（相对改善 7.7%，常规护理组下降 5.7%，组间时间交互作用的 p=0.03），并且有一次或多次初级保健就诊的比例也更高（HARP 组为 68.4%，常规护理组为 51.9%，组间时间交互作用的 p=0.046）。干预措施在与身体健康相关的生活质量（HRQOL）、身体活动、药物依从性方面具有优势，尽管没有统计学意义，但与一般医疗人群中的 CDSMP 相似。在医疗和社会弱势群体中，HRQOL 的改善最大。
这种由同行领导的、医疗自我管理计划是可行的，并为改善患有慢性合并症的精神健康消费者的一系列健康结果提供了希望。HARP 干预措施可能为精神健康同行劳动力提供一种手段，积极参与减少精神健康消费者的发病率和死亡率的努力。
