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


CONCLUSIONS
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.
Kilbourne
Amy M
AM
VA Ann Arbor Serious Mental Illness Treatment Research and Evaluation Center and Department of Psychiatry, University of Michigan; Ann Arbor, MI 48105, USA. amykilbo@umich.edu
Biswas
Kousick
K
Pirraglia
Paul A
PA
Sajatovic
Martha
M
Williford
William O
WO
Bauer
Mark S
MS
D001008:Anxiety Disorders / Q000453:epidemiology; D001714:Bipolar Disorder / Q000453:epidemiology / Q000628:therapy*; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002908:Chronic Disease; D015897:Comorbidity; D003299:Cooperative Behavior; D019468:Disease Management; D015987:Effect Modifier, Epidemiologic; D005260:Female; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D010353:Patient Education as Topic; D011615:Psychotherapy, Group; D011618:Psychotic Disorders / Q000453:epidemiology; D011788:Quality of Life; D012648:Self Care; D019966:Substance-Related Disorders / Q000453:epidemiology; D016896:Treatment Outcome