Lawless Mary Ellen, Kanuch Stephanie W, Martin Siobhan, Kaiser Denise, Blixen Carol, Fuentes-Casiano Edna, Sajatovic Martha, Dawson Neal V
MetroHealth Medical Center, Cleveland, OH.
University Hospitals Case Medical Center, Cleveland, OH.
Diabetes Spectr. 2016 Feb;29(1):24-31. doi: 10.2337/diaspect.29.1.24.
Patients with serious mental illness (SMI) and diabetes often seek care in primary care settings and have worse health outcomes than patients who have either illness alone. Individual, provider, and system-level barriers present challenges to addressing both psychiatric and medical comorbidities. This article describes the feasibility, acceptability, and implementation of Targeted Training and Illness Management (TTIM), a self-management intervention delivered by trained nurse educators and peer educators to groups of individuals with SMI and diabetes to improve self-management of both diseases. TTIM is intended to be delivered in a primary care setting. Findings are intended to support the future development of nurse-led programs within the primary care setting that teach self-management to individuals with concurrent SMI and diabetes. This approach supports both adaptability and flexibility in delivering the intervention. Interventions such as TTIM can provide self-management skills, accommodate people with both SMI and diabetes in primary care settings such as patient-centered medical homes, and address known barriers to access.
患有严重精神疾病（SMI）和糖尿病的患者经常在初级保健机构寻求治疗，并且与仅患有一种疾病的患者相比，他们的健康状况更差。个人、医疗服务提供者和系统层面的障碍给解决精神疾病和躯体疾病共病带来了挑战。本文描述了针对性培训与疾病管理（TTIM）的可行性、可接受性和实施情况，这是一种由经过培训的护士教育工作者和同伴教育工作者向患有SMI和糖尿病的个体群体提供的自我管理干预措施，旨在改善这两种疾病的自我管理。TTIM计划在初级保健机构实施。研究结果旨在支持未来在初级保健机构中由护士主导的项目的发展，这些项目向同时患有SMI和糖尿病的个体传授自我管理方法。这种方法在实施干预时支持适应性和灵活性。诸如TTIM这样的干预措施可以提供自我管理技能，在以患者为中心的医疗之家等初级保健机构中接纳同时患有SMI和糖尿病的人群，并解决已知的获取障碍。
