Is the collaborative chronic care model effective for patients with bipolar disorder and co-occurring conditions?

Kilbourne AM, Biswas K, Pirraglia PA, Sajatovic M, Williford WO, Bauer MS. Is the collaborative chronic care model effective for patients with bipolar disorder and co-occurring conditions? Journal of affective disorders. 2009 Jan 1; 112(1-3):256-61.

Related HSR&D Project(s)

• IIR 02-283 – Continuous Improvement for Veterans In Care-Mood Disorders
• IAB 07-115 – Implementing Integrated Care for Veterans with Serious Mental Illness

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Abstract:

BACKGROUND: The effectiveness of bipolar collaborative chronic care models (B-CCMs) among those with co-occurring substance use, psychiatric, and/or medical conditions has not specifically been assessed. We assessed whether B-CCM effects are equivalent comparing those with and without co-occurring conditions. METHODS: We reanalyzed data from the VA Cooperative Study #430 (n = 290), an 11-site randomized controlled trial of the B-CCM compared to usual care. Moderators included common co-occurring conditions observed in patients with bipolar disorder, including substance use disorders (SUD), anxiety, psychosis; medical comorbidities (total number), and cardiovascular disease-related conditions (CVD). Mixed-effects regression models were used to determine interactive effects between moderators and 3-year primary outcomes. RESULTS: Treatment effects were comparable for those with and without co-occurring substance use and psychiatric conditions, although possibly less effective in improving physical quality of life in those with CVD-related conditions (Beta = -6.11;p = 0.04). LIMITATIONS: Limitations included multiple comparisons and underpowered analyses of moderator effects. CONCLUSIONS: B-CCM effects were comparable in patients with co-occurring conditions, indicating that the intervention may be generally applied. Specific attention to physical quality of life in those with CVD maybe warranted.