Kilbourne Amy M, Bramlet Margretta, Barbaresso Michelle M, Nord Kristina M, Goodrich David E, Lai Zongshan, Post Edward P, Almirall Daniel, Verchinina Lilia, Duffy Sonia A, Bauer Mark S
VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI 48105, USA; Department of Psychiatry, University of Michigan Medical School, North Campus Research Complex, 2800 Plymouth Road, Building 16, Ann Arbor, MI 48109-2800, USA.
VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI 48105, USA.
Contemp Clin Trials. 2014 Sep;39(1):74-85. doi: 10.1016/j.cct.2014.07.007. Epub 2014 Jul 30.
Persons with serious mental illnesses (SMI) are more likely to die earlier than the general population, primarily due to increased medical burden, particularly from cardiovascular disease (CVD). Life Goals Collaborative Care (LG-CC) is designed to improve health outcomes in SMI through self-management, care management, and provider support. This single-blind randomized controlled effectiveness study will determine whether patients with SMI receiving LG-CC compared to usual care (UC) experience improved physical health in 12 months.
Patients diagnosed with SMI and at least one CVD risk factor receiving care at a VA mental health clinic were randomized to LG-CC or UC. LG-CC included five self-management sessions covering mental health symptom management reinforced through health behavior change, care coordination and health monitoring via a registry, and provider feedback. The primary outcome is change in physical health-related quality of life score (VR-12) from baseline to 12 months. Secondary outcomes include changes in mental health-related quality of life, CVD risk factors (blood pressure, BMI), and physical activity from baseline to 12 months later.
Out of 304 enrolled, 139 were randomized to LG-CC and 145 to UC. Among patients completing baseline assessments (N = 284); the mean age was 55.2 (SD = 10.9; range 28-75 years), 15.6% were women, the majority (62%) were diagnosed with depression, and the majority (63%) were diagnosed with hypertension or were overweight (BMI mean ± SD = 33.3 ± 6.3). Baseline VR-12 physical health component score was below population norms (50.0 ± SD = 10) at 33.4 ± 11.0.
Findings from this trial may inform initiatives to improve physical health for SMI patient populations.
患有严重精神疾病（SMI）的人比一般人群更早死亡的可能性更高，主要是由于医疗负担增加，尤其是心血管疾病（CVD）。生活目标协作护理（LG - CC）旨在通过自我管理、护理管理和提供者支持来改善SMI患者的健康结局。这项单盲随机对照有效性研究将确定与常规护理（UC）相比，接受LG - CC的SMI患者在12个月内身体健康是否得到改善。
在退伍军人事务部精神卫生诊所接受治疗且被诊断为SMI并至少有一个CVD风险因素的患者被随机分配到LG - CC组或UC组。LG - CC包括五个自我管理课程，涵盖通过健康行为改变强化的心理健康症状管理、通过注册表进行的护理协调和健康监测以及提供者反馈。主要结局是从基线到12个月时与身体健康相关的生活质量评分（VR - 12）的变化。次要结局包括从基线到12个月后与心理健康相关的生活质量、CVD风险因素（血压、BMI）和身体活动的变化。
在304名入组患者中，139名被随机分配到LG - CC组，145名被随机分配到UC组。在完成基线评估的患者中（N = 284）；平均年龄为55.2岁（标准差 = 10.9；范围28 - 75岁），15.6%为女性，大多数（62%）被诊断为抑郁症，大多数（63%）被诊断为高血压或超重（BMI平均值±标准差 = 33.3 ± 6.3）。基线时VR - 12身体健康成分评分低于人群标准（50.0 ±标准差 = 10），为33.4 ± 11.0。
该试验的结果可能为改善SMI患者群体身体健康的举措提供参考。
