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1.
Psychiatr Serv ; 68(9): 883-890, 2017 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-28502243

RESUMO

OBJECTIVES: A 60-week randomized controlled trial assessed the effects of targeted training in illness management (TTIM) versus treatment as usual among 200 individuals with serious mental illness and diabetes mellitus. METHODS: The study used the Clinical Global Impression (CGI), the Montgomery-Asberg Depression Rating Scale (MADRS), and the Brief Psychiatric Rating Scale (BPRS) to assess psychiatric symptoms; the Global Assessment of Functioning (GAF) and the Sheehan Disability Scale (SDS) to assess functioning; the 36-Item Short-Form Health Survey (SF-36) to assess general health, and serum glycosylated hemoglobin (HbA1c) to assess diabetes control. RESULTS: Participants' mean±SD age was 52.7±9.5 years, and 54% were African American. They were diagnosed as having depression (48%), schizophrenia (25%), and bipolar disorder (28%). At baseline, depression severity was substantial but psychosis severity was modest. At 60 weeks, there was greater improvement among TTIM participants versus treatment-as-usual recipients on the CGI (p<.001), the MADRS (p=.016), and the GAF (p=.003). Diabetes knowledge was significantly improved among TTIM participants but not in the treatment-as-usual group. In post hoc analyses among participants whose HbA1c levels at baseline met recommendations set by the American Diabetes Association for persons with high comorbidity (53%), TTIM participants had minimal change in HbA1c over the 60-week follow-up, whereas HbA1c levels worsened in the treatment-as-usual group. CONCLUSIONS: TTIM was associated with improved psychiatric symptoms, functioning, and diabetes knowledge compared with treatment as usual. Among participants with better diabetes control at baseline, TTIM participants had better diabetes control at 60 weeks compared with recipients of treatment as usual.


Assuntos
Transtorno Bipolar/terapia , Transtorno Depressivo/terapia , Diabetes Mellitus/terapia , Avaliação de Resultados em Cuidados de Saúde , Esquizofrenia/terapia , Autogestão/métodos , Adulto , Transtorno Bipolar/epidemiologia , Comorbidade , Transtorno Depressivo/epidemiologia , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Esquizofrenia/epidemiologia
2.
Prim Health Care Res Dev ; 16(2): 127-37, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24703014

RESUMO

AIM: To describe the training and participant experience of patients with both severe mental illness (SMI) and diabetes (DM) who were enrolled in a Peer Educator Training Program adapted to a primary health care setting. BACKGROUND: The mortality of patients with both SMI and DM is high. Illness self-management includes medications, psychosocial treatments, and healthy behaviors, yet treatment engagement is often sub-optimal with adherence rates of 52% for diabetic medications and 62% for antipsychotic medications among the SMI. To address this problem, a new behavioral intervention study targeting SMI and DM self-management used trained peer educators (PEs) with the same chronic conditions to enhance program effectiveness. A manual facilitated training on intervention topics such as SMI and DM therapies, stress management, and stigma reduction as well as training in group intervention techniques, telephone skills, and crisis management. METHODS: We assessed PE attitudes and input using in-depth face-to-face interviews. Interviews were audio-taped, transcribed, coded, and analyzed using the classic method of content analysis emphasizing dominant themes. A member check-in was conducted where participants commented on analysis results. FINDINGS: Six relevant descriptive themes emerged: (1) positive group experience; (2) success with learning manual content; (3) increased knowledge about SMI and DM; (4) improved self-management skills; (5) increased self-confidence and self-efficacy in becoming a PE; and being (6) united in purpose to help others self-manage their SMI and DM. Qualitative evidence supports structured training for SMI-DM PEs. Key components include written educational materials and the power of the group process to increase knowledge, self-management skills, confidence, and self-efficacy. Recommendations are offered to support further endeavors to mobilize peers with SMI to help other patients with complex comorbidities better manage their own health.


Assuntos
Diabetes Mellitus/terapia , Transtornos Mentais/terapia , Grupo Associado , Atenção Primária à Saúde/métodos , Avaliação de Programas e Projetos de Saúde/estatística & dados numéricos , Autocuidado/métodos , Diabetes Mellitus/psicologia , Feminino , Seguimentos , Comportamentos Relacionados com a Saúde , Promoção da Saúde/métodos , Humanos , Entrevistas como Assunto , Masculino , Transtornos Mentais/complicações , Transtornos Mentais/psicologia , Pessoa de Meia-Idade
3.
Am J Surg ; 204(2): 199-202, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22317948

RESUMO

BACKGROUND: The objective of this study was to determine whether health care disparities exist in management of Graves' disease. METHODS: Patients treated for Graves' disease from 1999 to 2009 were divided into medical and surgical treatment groups. A comparative analysis of age, sex, race, health insurance, and income was completed. Address and/or zip code were geocoded and median income was determined from census data. RESULTS: A total of 634 patients were treated for Graves' disease; 535 (84%) medically and 99 (16%) surgically. Mean age (40 ± 15 vs 43 ± 11 y), percentage of women (84% vs 91%), and racial distribution were similar in the 2 groups (P > .05). In the surgical group, median income was lower ($31,530 vs $34,404; P = .07) and 52% of patients were uninsured compared with 30% of patients treated medically (P < .0001). CONCLUSIONS: A disproportionate number of uninsured patients underwent thyroidectomy for Graves' disease. Social and economic factors may have a role in determining definitive therapy for Graves' disease.


Assuntos
Doença de Graves/terapia , Disparidades em Assistência à Saúde , Técnicas de Ablação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antitireóideos/uso terapêutico , Compostos de Cálcio/uso terapêutico , Criança , Pré-Escolar , Uso de Medicamentos/estatística & dados numéricos , Feminino , Doença de Graves/epidemiologia , Humanos , Hipocalcemia/tratamento farmacológico , Hipocalcemia/etiologia , Renda , Radioisótopos do Iodo/uso terapêutico , Masculino , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Pessoa de Meia-Idade , Ohio/epidemiologia , Cooperação do Paciente/estatística & dados numéricos , Preferência do Paciente/estatística & dados numéricos , Grupos Raciais/estatística & dados numéricos , Distribuição por Sexo , Nódulo da Glândula Tireoide/epidemiologia , Nódulo da Glândula Tireoide/cirurgia , Tireoidectomia/estatística & dados numéricos , População Urbana , Vitamina D/uso terapêutico , Vitaminas/uso terapêutico , Adulto Jovem
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