Service delivery in older patients with bipolar disorder: a review and development of a medical care model.
OBJECTIVE
Medical comorbidities, especially cardiovascular disease (CVD), occur disproportionately in older patients with bipolar disorder. We describe the development, implementation, and feasibility/tolerability results of a manual-based medical care model (BCM) designed to improve medical outcomes in older patients with bipolar disorder.


METHODS
The BCM consisted of (i) self-management sessions focused on bipolar disorder symptom control, healthy habits, and provider engagement, (ii) telephone care management to coordinate care and reinforce self-management goals, and (iii) guideline dissemination focused on medical issues in bipolar disorder. Older patients with bipolar disorder and a CVD-related risk factor (n = 58) were consented, enrolled, and randomized to receive BCM or usual care.


RESULTS
Baseline assessment (mean age = 55, 9% female, 9% African American) revealed a vulnerable population: 21% were substance users, 31% relied on public transportation, and 22% reported problems accessing medical care. Evaluation of BCM feasibility revealed high overall patient satisfaction with the intervention, high fidelity (e.g., majority of self-management sessions and follow-up contacts completed), and good tolerability (dropout rate <5%). Use of telephone contacts may have mitigated barriers to medical care (e.g., transportation).


CONCLUSIONS
The BCM is a feasible model for older, medically ill patients with bipolar disorder, and could be an alternative to more costly treatment models that involve co-location and/or additional hiring of medical providers in mental health clinics. Future research directions pertinent to the development of the BCM and other medical care models for older patients with bipolar disorder include assessment of their long-term effects on physical health and their cost-effectiveness across different treatment settings.
VA Ann Arbor National Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor, MI 48105, USA. amykilbo@umich.edu
Amy M
AM
Kilbourne
Edward P
EP
Post
Agnes
A
Nossek
Elif
E
Sonel
Larry J
LJ
Drill
Susan
S
Cooley
Mark S
MS
Bauer
D000328:Adult; D000368:Aged; D001714:Bipolar Disorder / Q000209:etiology / Q000628:therapy*; D002318:Cardiovascular Diseases / Q000150:complications / Q000453:epidemiology; D005260:Female; D005853:Geriatrics; D017408:Guidelines as Topic; D006302:Health Services Research; D006701:Home Nursing; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000191:economics; D008875:Middle Aged; D008962:Models, Theoretical; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D017216:Telemedicine