title: Integrated IMR for psychiatric and general medical illness for adults aged 50 or older with serious mental illness.
abstract: OBJECTIVE
  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.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Bartels
authors.forename: Sarah I
authors.initials: SI
authors.lastname: Pratt
authors.forename: Kim T
authors.initials: KT
authors.lastname: Mueser
authors.forename: John A
authors.initials: JA
authors.lastname: Naslund
authors.forename: Rosemarie S
authors.initials: RS
authors.lastname: Wolfe
authors.forename: Meghan
authors.initials: M
authors.lastname: Santos
authors.forename: Haiyi
authors.initials: H
authors.lastname: Xie
authors.forename: Erik G
authors.initials: EG
authors.lastname: Riera
mesh_terms: D000368:Aged; D010054:Brief Psychiatric Rating Scale; D002908:Chronic Disease / Q000453:epidemiology / Q000628:therapy*; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000628:therapy; D019468:Disease Management; D005240:Feasibility Studies; D007722:Health Knowledge, Attitudes, Practice; D006296:Health Services / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000628:therapy*; D008875:Middle Aged; D009513:New Hampshire; D010353:Patient Education as Topic / Q000379:methods*; D010865:Pilot Projects; D011613:Psychotherapy / Q000379:methods; D012008:Recurrence; D055502:Secondary Prevention; D012648:Self Care / Q000379:methods* / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D016896:Treatment Outcome