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Long-term effectiveness and cost of a systematic care program for bipolar disorder.
Arch Gen Psychiatry. 2006 May; 63(5):500-8.AG

Abstract

CONTEXT

Despite the availability of efficacious treatments, the long-term course of bipolar disorder is often unfavorable.

OBJECTIVE

To test the effectiveness of a multicomponent intervention program to improve the quality of care and long-term outcomes for persons with bipolar disorder.

DESIGN

Randomized controlled trial with allocation concealment and blinded outcome assessment.

SETTING

Mental health clinics of a group-model prepaid health plan.

PATIENTS

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.

INTERVENTIONS

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.

MAIN OUTCOME MEASURES

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.

RESULTS

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.

CONCLUSIONS

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.

Authors+Show Affiliations

Center for Health Studies, Group Health Cooperative, and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle 98101, USA. simon.g@ghc.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16651507

Citation

Simon, Gregory E., et al. "Long-term Effectiveness and Cost of a Systematic Care Program for Bipolar Disorder." Archives of General Psychiatry, vol. 63, no. 5, 2006, pp. 500-8.
Simon GE, Ludman EJ, Bauer MS, et al. Long-term effectiveness and cost of a systematic care program for bipolar disorder. Arch Gen Psychiatry. 2006;63(5):500-8.
Simon, G. E., Ludman, E. J., Bauer, M. S., Unützer, J., & Operskalski, B. (2006). Long-term effectiveness and cost of a systematic care program for bipolar disorder. Archives of General Psychiatry, 63(5), 500-8.
Simon GE, et al. Long-term Effectiveness and Cost of a Systematic Care Program for Bipolar Disorder. Arch Gen Psychiatry. 2006;63(5):500-8. PubMed PMID: 16651507.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term effectiveness and cost of a systematic care program for bipolar disorder. AU - Simon,Gregory E, AU - Ludman,Evette J, AU - Bauer,Mark S, AU - Unützer,Jürgen, AU - Operskalski,Belinda, PY - 2006/5/3/pubmed PY - 2006/6/1/medline PY - 2006/5/3/entrez SP - 500 EP - 8 JF - Archives of general psychiatry JO - Arch Gen Psychiatry VL - 63 IS - 5 N2 - CONTEXT: Despite the availability of efficacious treatments, the long-term course of bipolar disorder is often unfavorable. OBJECTIVE: To test the effectiveness of a multicomponent intervention program to improve the quality of care and long-term outcomes for persons with bipolar disorder. DESIGN: Randomized controlled trial with allocation concealment and blinded outcome assessment. SETTING: Mental health clinics of a group-model prepaid health plan. PATIENTS: 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. INTERVENTIONS: 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. MAIN OUTCOME MEASURES: 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. RESULTS: 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. CONCLUSIONS: 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. SN - 0003-990X UR - https://www.unboundmedicine.com/medline/citation/16651507/Long_term_effectiveness_and_cost_of_a_systematic_care_program_for_bipolar_disorder_ L2 - https://jamanetwork.com/journals/jamapsychiatry/fullarticle/10.1001/archpsyc.63.5.500 DB - PRIME DP - Unbound Medicine ER -