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Articles   |    
Integrated IMR for Psychiatric and General Medical Illness for Adults Aged 50 or Older With Serious Mental Illness
Stephen J. Bartels, M.D., M.S.; Sarah I. Pratt, Ph.D.; Kim T. Mueser, Ph.D.; John A. Naslund, M.P.H.; Rosemarie S. Wolfe, M.S.; Meghan Santos, M.S.W.; Haiyi Xie, Ph.D.; Erik G. Riera, Ed.M., M.B.A.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300023
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Dr. Bartels, Dr. Pratt, Ms. Wolfe, and Ms. Santos are with the Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, where Dr. Bartels is also with the Department of Community and Family Medicine and Mr. Naslund is with the Dartmouth Institute for Health Policy and Clinical Practice (e-mail: sjbartels@dartmouth.edu). Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. Xie is with the Dartmouth Psychiatric Research Center, Lebanon. Mr. Riera is with the New Hampshire Bureau of Behavioral Health, Concord.

Copyright © 2014 by the American Psychiatric Association

Abstract

Objectives  Self-management is promoted as a strategy for improving outcomes for serious mental illness as well as for chronic general medical conditions. This study evaluated the feasibility and effectiveness of an eight-month program combining training in self-management for both psychiatric and general medical illness, including embedded nurse care management.

Methods  Participants were 71 middle-aged and older adults (mean age=60.3±6.5) with serious mental illness and chronic general medical conditions who were randomly assigned to receive integrated Illness Management and Recovery (I-IMR) (N=36) or usual care (N=35). Feasibility was determined by attendance at I-IMR and nurse sessions. Effectiveness outcomes were measured two and six months after the intervention (ten- and 14-month follow-ups) and included self-management of psychiatric and general medical illness, participation in psychiatric and general medical encounters, and self-reported acute health care utilization.

Results  I-IMR participants attended 15.8±9.5 I-IMR and 8.2±5.9 nurse sessions, with 75% attending at least ten I-IMR and five nurse sessions. Compared with usual care, I-IMR was associated with greater improvements in participant and clinician ratings for psychiatric illness self-management, greater diabetes self-management, and an increased preference for detailed diagnosis and treatment information during primary care encounters. The proportion of I-IMR participants with at least one psychiatric or general medical hospitalization decreased significantly between baseline and ten- and 14-month follow-ups.

Conclusions  I-IMR is a feasible intervention for this at-risk group and demonstrated potential effectiveness by improving self-management of psychiatric illness and diabetes and by reducing the proportion of participants requiring psychiatric or general medical hospitalizations.

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Figure 1 Proportion of participants assigned to I-IMR or usual care who reported a hospitalization in the three months before baseline and 10- and 14-month follow-upsa

a I-IMR, integrated Illness Management and Recovery. The proportion of I-IMR participants who reported a hospitalization decreased significantly (χ2=4.36, df=1, p=.037).

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Table 1Characteristics of participants assigned to integrated Illness Management and Recovery (I-IMR) or usual carea
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a All characteristics were compared by chi square test, except age, which was compared by t test. Between-group differences were not significant.

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b Chronic obstructive pulmonary disease

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Table 2Outcomes of integrated Illness Management and Recovery (I-IMR) and usual care at baseline and 10- and 14-month follow-upsa
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a Scores are reported in raw (unadjusted) means.

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b Main effects between 10- and 14-month follow-ups were adjusted for baseline value as a covariate.

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c The effect size (ES) was calculated for endpoint ES (not overall group effect).

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d IMR, Illness Management and Recovery. Possible scores range from 1 to 5, with higher scores indicating better psychiatric illness self-management skills.

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e Possible scores range from 1 to 10, with higher scores indicating greater self-efficacy.

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f Possible scores range from 0 to 4, with higher scores indicating greater diabetes self-management.

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g COPD, chronic obstructive pulmonary disease. Possible scores range from 0 to 4, with higher scores indicating greater COPD self-management.

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h Possible total scores range from 24 to 68, with higher scores indicating greater psychiatric illness severity.

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i Possible scores range from 1 to 5, with higher scores indicating better community functioning.

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j Possible scores range from 0 to 100, with higher scores indicating greater preference for detailed diagnosis and treatment information.

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k Possible scores range from 0 to 100, with higher scores indicating greater preference for decision making.

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l Possible scores range from 0 to 5, with higher scores indicating a more active role in communicating questions and needs.

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