Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

1037 — Improving General Medical Care for Patients with Bipolar Disorder: A Randomized, Controlled Trial

Kilbourne AM (VA Pittsburgh CHERP) , Bauer MS (Providence VAMC), Nossek A (VA Pittsburgh), Drill LJ (VA Pittsburgh), Cooley S (VA Pittsburgh), Post EP (University of Pittsburgh)

Objectives:
Medical comorbidities, especially cardiovascular disease (CVD) occur disproportionately in bipolar disorder. However, the quality of medical care and medical outcomes for persons with bipolar or other mental disorders are suboptimal. Manual-based treatment models such as the Chronic Care Model (CCM) can address CVD risk and may be a cost-efficient approach for improving coordination and continuity of medical care in mental health settings. We pilot-tested a medical CCM for bipolar disorder (“BCM”) and determined whether, compared to usual care, veterans randomized to receive the BCM had improved outcomes.

Methods:
Patients (N=60) with bipolar disorder and a CVD-related condition were consented, enrolled, and randomized to receive the BCM or usual care. The BCM consisted of 1) self-management sessions based on the Bauer Life Goals program (VA Cooperative Studies #430), focused on bipolar disorder symptom control and modified to address diet/exercise habits and provider engagement, 2) telephone care management to coordinate medical/psychiatric care, and 3) guideline dissemination focused on medical issues in bipolar disorder. Patients completed outcome assessments at baseline, 3, and 6 months, and analysis of variance was used to compare changes in outcomes between BCM and usual care groups.

Results:
Among study participants (mean age=55, 11% female, 9% African-American), 52% had >=2 CVD-related conditions. Three-month outcomes revealed that changes in SF-12 physical health scores were greater for the BCM compared to usual care (F=3.77,p=0.05). Changes in euthymic (well-being) symptoms were also greater in the BCM compared to usual care group (F=4.86,p=0.03).

Implications:
The BCM may improve outcomes for veterans with bipolar disorder and co-occurring CVD, and is a promising model for psychiatric settings that cannot afford co-locating medical providers.

Impacts:
Bipolar disorder is a highly disabling condition associated with substantial societal costs. Patients with bipolar disorder are especially at risk for CVD because of alternating manic and depressive symptoms that lead to nonadherence, overeating, and sedentary behavior. Improving medical outcomes for persons with bipolar disorder and other serious mental illnesses is a priority articulated by the VA Mental Health Strategic Plan. Our findings will help inform the business case for implementing CCMs for veterans with mental disorders across the VA.