Collaborative chronic care tackles comorbidity in bipolar patients
By Eleanor McDermid, Senior medwireNews Reporter
02 August 2013
J Clin Psychiatry 2013; 74: e655

medwireNews: A collaborative chronic care model helps patients with bipolar disorder to reduce their cardiovascular disease (CVD) risk, shows a randomized trial.

Unlike some forms of chronic care management, the model assessed in this trial was based chiefly on helping patients to self-manage, “in part,” say the researchers, “because many of the CVD risk factors were potentially mutable to health behavior change.”

The heavy focus on self-management makes the intervention “potentially more scalable to implement by existing providers in routine practice than care management,” they note in the Journal of Clinical Psychiatry.

The 58 patients assigned to receive the study intervention – the Life Goals Collaborative Care (LGCC) intervention – had four group sessions, lasting 90 to 120 minutes and led by a health specialist, which focused on self-management of affective symptoms and CV risk factors.

The health specialist then maintained at least monthly contact with the patients, to reinforce the self-management lessons and assist communication with healthcare providers.

Over the next 24 months, patients’ systolic blood pressure fell from a mean of 131.8 to 127.2 mmHg, which was borderline significant (p=0.05) relative to the decrease from 133.8 to 130.4 mmHg seen in the 60 patients assigned to “enhanced” usual care (sent quarterly health newsletters). Diastolic blood pressure fell from 80.7 to 75.9 mmHg in the intervention group and from 83.8 to 78.5 mmHg in the usual care group. The fall in the intervention group was found to be significantly larger in repeated measures analyses that took into account differences in diastolic blood pressure at baseline as well as other factors such as obesity.

Blood cholesterol and health-related quality of life were not affected by the intervention. However, lead researcher Amy Kilbourne (VA Ann Arbor Center for Clinical Management Research, Michigan, USA) and colleagues note that the size of blood pressure reduction seen in their trial has been linked to a 14% reduction in stroke mortality and a 9% reduction in CVD mortality.

Given that CVD is a major cause of healthcare expense and mortality in bipolar disorder patients, “interventions that address gaps in physical as well as mental health outcomes are paramount for this group,” they say.

They add: “To our knowledge, this is the first study to demonstrate reductions in CVD risk factors for persons with bipolar disorder seen in primary or mental health specialty care settings.”

Notably, and consistent with previous studies, the intervention also resulted in a significant reduction in manic symptoms, relative to usual care, with scores on the Internal State Scale falling from 190.5 to 148.9 versus 183.5 to 173.4.

medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

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