Study Find Peer-led Health Promotion Program Produced Significant Improvements

NYAPRS Note: A groundbreaking study that is now available online has found that a group of individuals diagnosed with serious physical and mental health conditions who participated in a peer-led health promotion “self-management’ program helped them to demonstrate “a significant differential improvement in their health-related quality of life.” See below for excerpts taken from the study at . To see the complete study, including tables showing specific outcomes, you must purchase the study athttps://ps.psychiatryonline.org/doi/full/10.1176/appi.ps.201700352.  

Hopefully, this will press state and local behavioral health systems and health care payers to make significant investments in peer-led health and wellness promotion and support programs. Stay tuned for more!

Peer-Led Self-Management of General Medical Conditions for Patients With Serious Mental Illnesses: A Randomized Trial

Druss et al  February 01, 2018

https://ps.psychiatryonline.org/doi/full/10.1176/appi.ps.201700352

Study Excerpts by NYAPRS

Funded by the National Institute of Mental Health and conducted between September 2011 and August 2016, this is “largest and first fully powered randomized trial of a peer-led intervention to address self-management of general medical conditions among patients with serious mental illness.”

Underlying Premises

· “Individuals with serious mental illnesses have high rates of general medical comorbidity and challenges in managing these conditions” that all too often have led to premature mortality.

· “Addressing chronic general medical conditions requires not only high-quality medical care but also effective self-management of these illnesses outside provider visits.”

· “Many of the same risk factors that place individuals with serious mental illness at risk of developing chronic general medical conditions…included psychiatric symptoms, limited health literacy and poverty.”

Study Participants

· A majority of the 400 participants were female, African American, and poor; nearly all were uninsured or covered by public insurance (Table 1). “The most common psychiatric diagnoses were major depression, bipolar disorder, and schizophrenia, and the most common chronic general medical conditions were hypertension, hyperlipidemia, asthma or COPD, and diabetes.”

Method

· 198 participants were randomly assigned to the Health and Recovery Peer (HARP) program, a self-management program for general medical conditions led by 4 certified peer specialists and 200 continued to be engaged in usual care.

The Intervention

· “The HARP program comprised six sessions of two-and-a-half hours each that address the following: information about chronic general medical conditions, use of action planning, healthy diet and exercise on a budget, communicating with health care providers, medication and other treatments, and working across the health system.

· One-on-one peer coaching meetings were held between group sessions to reinforce messages and skills taught at each group session. A structured manual and worksheets were provided to all participants to support development of key competencies and skills.

· A total of six to ten participants were included in each cohort, and each group session was led by two certified peer specialists.

· Training was provided in buying and preparing food on a limited budget, including interactive cooking demonstrations. The physical activity section incorporated a training session for exercises that could be done at home without special equipment. Participants were encouraged to exchange contact information to develop social networks and provide support in meeting their health goals.”

NYAPRS: see more on the HARP model at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2856811/

Results

· “At six months, participants in the intervention group demonstrated a significant differential improvement in the primary study outcome, health-related quality of life.” To see the tables showing specific outcomes, you must purchase the study athttps://ps.psychiatryonline.org/doi/full/10.1176/appi.ps.201700352 .

Implications

· “This study provides evidence that these programs hold the potential to improve the health and well-being of patients with serious mental illnesses.”

· “The findings suggest the potential benefits of more widespread dissemination of peer-led general medical disease self-management groups in this population.”

Researchers

Benjamin G. Druss, M.D., M.P.H., Manasvini Singh, M.S.P.H., Silke A. von Esenwein, Ph.D., Gretl E. Glick, M.P.H., Stephanie Tapscott, M.S.W., Sherry Jenkins Tucker, M.A., Cathy A. Lally, M.S.P.H.,Evelina W. Sterling, Ph.D. Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia.

Send correspondence to Dr. Druss at bdruss@emory.edu