Long-term effectiveness and cost of a systematic care program for bipolar disorder

Center for Health Studies, Group Health Cooperative, and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle 98101, USA.
Archives of General Psychiatry (Impact Factor: 13.75). 06/2006; 63(5):500-8. DOI: 10.1001/archpsyc.63.5.500
Source: PubMed

ABSTRACT Despite the availability of efficacious treatments, the long-term course of bipolar disorder is often unfavorable.
To test the effectiveness of a multicomponent intervention program to improve the quality of care and long-term outcomes for persons with bipolar disorder.
Randomized controlled trial with allocation concealment and blinded outcome assessment.
Mental health clinics of a group-model prepaid health plan.
Of 785 patients in treatment for bipolar disorder who were invited to participate, 509 attended an evaluation appointment, 450 were found eligible to participate, and 441 enrolled in the trial.
Participants were randomly assigned to a multicomponent intervention program or to continued care as usual. Three nurse care managers provided a 2-year systematic intervention program, including the following: a structured group psychoeducational program, monthly telephone monitoring of mood symptoms and medication adherence, feedback to treating mental health providers, facilitation of appropriate follow-up care, and as-needed outreach and crisis intervention.
In-person blinded research interviews every 3 months assessed mood symptoms using the Longitudinal Interval Follow-up Examination. Health plan administrative records were used to assess the use and cost of mental health services.
Intent-to-treat analyses demonstrated that the intervention significantly reduced the mean level of mania symptoms (z = 2.09, P = .04) and the time with significant mania symptoms (19.2 vs 24.7 weeks; F(1) = 6.0, P = .01). There was no significant intervention effect on mean level of depressive symptoms (z = 0.19, P = .85) or time with significant depressive symptoms (47.6 vs 50.7 weeks; F(1) = 0.56, P = .45). Benefits of the intervention were found only in a subgroup of 343 persons with clinically significant mood symptoms at the baseline assessment. The incremental cost (adjusted) of the intervention was 1251 dollars (95% confidence interval, 55-2446 dollars), including approximately 800 dollars for the intervention program services and an approximate 500 dollars increase in the costs of other mental health services.
Population-based systematic care programs can significantly reduce the frequency and severity of mania in bipolar disorder, and cost increases are modest considering the clinical gains. The incorporation of more specific cognitive and behavioral content or more effective medication regimens may be necessary to significantly reduce the symptoms of depression.

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    • "Collaborative Care Models (CCMs) [11], which provide proactive care for patients through self-management education, coordination of services, and ongoing follow-up with patients and communications with providers by a care manager have been shown to improve medical and psychiatric outcomes, primarily for patients with depression [12]. More recently, Life Goals Collaborative Care (LG-CC), a CCM-based intervention developed to address physical health and CVD risk in patients with bipolar disorder, led to improved mental health physical health outcomes [13] [14] [15] [16]. LG-CC adds components of health behavior change to the CCM components, notably by linking symptom management with healthy behavior goal-setting, as well as follow-up on physical and mental health symptoms and care. "
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    Contemporary Clinical Trials 09/2014; 39(1). DOI:10.1016/j.cct.2014.07.007 · 1.99 Impact Factor
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    • "Although most randomized controlled trials have been tested on depression, two trials (Bauer et al. 2006a; Simon et al. 2006) have tested the effectiveness of collaborative models for adults with bipolar disorder. These trials have shown improvements in clinical outcomes, social role functioning, quality of life, and general patient satisfaction (Bauer et al. 2006b; Bauer et al. 2009; Kilbourne et al. 2008; Simon et al. 2006). Second, there is a need to tailor treatments to meet the needs of adolescents, minorities, and disabled children. "
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    Administration and Policy in Mental Health and Mental Health Services Research 04/2014; 42(2). DOI:10.1007/s10488-014-0553-5 · 3.44 Impact Factor
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    • "The core components of shared care models for severe and persistent mental disorders COPERATIVE STUDIES PROGRAM 430 Bauer 2009 Simon 2006 OPUS Bertelson 2008 "
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