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Enhancing multiyear guideline concordance for bipolar disorder through collaborative care.
Mark S Bauer1, Kousick Biswas, Amy M Kilbourne
1Harvard Medical School and the Center for Organization, Leadership, and Management Research, Boston VA Healthcare System, MA, USA. mark.bauer@va.gov
The American Journal of Psychiatry
|October 3, 2009
Summary
A collaborative care model significantly improved long-term adherence to treatment guidelines for bipolar disorder (BD) in veterans. This approach enhances evidence-based care and patient outcomes over three years.
Area of Science:
- Psychiatry
- Health Services Research
- Evidence-Based Medicine
Background:
- Implementing evidence-based care for serious mental illnesses like bipolar disorder (BD) remains a challenge.
- Sustaining concordance with clinical practice guidelines is crucial for improving patient outcomes.
- Limited data exist on long-term guideline concordance for BD beyond one year.
Observation:
- A 3-year multiregion effectiveness trial involved 306 veterans with BD.
- Participants were randomized to either a collaborative care model or usual care post-hospital discharge.
- Guideline concordance for antimanic pharmacotherapy was assessed over six 6-month periods.
Findings:
- The collaborative care model demonstrated significantly higher rates of guideline-concordant antimanic treatment compared to usual care.
- Higher baseline guideline concordance was associated with improved long-term adherence.
- Patient age and bipolar type did not significantly influence concordance rates.
Implications:
- Multicomponent collaborative care models can effectively improve long-term guideline concordance in BD treatment.
- These models integrate provider support, patient self-management, and facilitated care access.
- Sustained improvements in care quality are achievable even for severely impaired patients.
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