1092 — Multisite Randomized Controlled Trial of Life Goals Collaborative Care to Reduce CVD Risk in Patients with Serious Mental Illness
Kilbourne AM, Goodrich D, Lai Z, and Chermack S, VA Ann Arbor CCMR/SMITREC; Bauer MS, VA Boston COLMR;
Persons with serious mental illness (SMI) experience a disproportionate burden of medical comorbidity, notably cardiovascular disease (CVD), leading to premature mortality. Patients with bipolar disorder, which is the most commonly diagnosed SMI in VA, are especially vulnerable to CVD because of multilevel risk factors (poor health habits, symptoms, medication side effects, fragmentation of care). The purpose of this multisite randomized controlled effectiveness trial is to determine whether, compared to enhanced usual care, Life Goals Collaborative Care (LGCC), a chronic care model incorporating health behavior change strategies, reduces CVD risk factors and improves outcomes in 12 months among individuals with bipolar disorder.
Patients with bipolar disorder and >=1 CVD risk factors were recruited from two VA Ann Arbor primary and specialty care clinics and two comparable community-based mental health clinics, and randomized to LGCC or enhanced usual care (mailings on wellness topics in addition to standard mental health and medical treatment). LGCC included the Life Goals self-management program (four 2-hour lifestyle coaching sessions plus regular phone contacts on behavior change in the context of symptom management), medical care coordination by a care manager, and provider guideline dissemination. Primary outcome measures included CVD risk factors, Framingham Risk Score, psychiatric symptoms, and health-related quality of life.
A total of 183 patients were enrolled (64% Veterans, mean age = 50, 32% female, 14% minority). Repeated measures analyses comparing changes in 12-month outcomes for LGCC (N = 90) and enhanced usual care (N = 93) revealed that patients receiving LGCC had reduced BMI (Beta = 2.8, P <.01), waist circumference (B = 2.6, P <.01), total cholesterol (B = 15.7, p = .03), and Framingham risk (B = 3.2, P = .03). LGCC patients also had reduced depressive symptoms (B = 2.3, p <.01) over the 12-month follow-up period. VA patients were more responsive to the effects of LGCC, notably through reduced blood pressure and improved self-efficacy.
In both VA and non-VA patient populations, LGCC compared to enhanced usual care led to reduced CVD risk and depressive symptoms.
LGCC may reduce CVD risk factors across different treatment settings and could potentially be disseminated in VA settings under emerging patient-aligned care team and behavioral medicine initiatives for vulnerable Veteran populations.