Collaborative care for bipolar disorder: Part II. Impact on clinical outcome, function, and costs
Collaborative care for bipolar disorder: Part II. Impact on clinical outcome, function, and costs
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DOI：
10.1176/appi.ps.57.7.937
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发表时间：
2006-07-01
影响因子：
3.8
通讯作者：
Sajatovic, Martha
中科院分区：
文献类型：
--
作者：
Bauer, Mark S.;McBride, Linda;Sajatovic, Martha
目的：该研究探讨了第一部分（本期）中描述的慢性病护理合作模式是否能改善双相情感障碍的结局。研究方法：干预的目的是通过提高病人的自我管理技能与团体心理教育，提供临床医生的决策支持与简化的实践指南，并改善获得护理，护理的连续性，并通过护士护理协调员的信息流，以改善结果。在一项有效性设计中，11家退伍军人事务部医院的双相情感障碍退伍军人被随机分配到三年的干预护理或继续常规护理。每八周进行一次盲法临床和功能测量。意向治疗分析（N=306）与混合效应模型解决了这一假设，即改善将在三年内累积，与社会学习理论一致。结果：干预显著减少了情感发作周数，主要是躁狂。在社会角色功能、心理生活质量和治疗满意度方面表现出广泛的改善。平均躁狂和抑郁症状的减少并不显著。干预是成本中性的，同时实现了6.2周的情感发作的净减少。结论：合作慢性护理模式可以改善双相情感障碍的一些长期临床结局。功能和生活质量的好处也得到了证明，大多数好处在第2年和第3年积累。
Objective: The study addressed whether a collaborative model for chronic care, described in part I ( this issue), improves outcome for bipolar disorder. Methods: The intervention was designed to improve outcome by enhancing patient self-management skills with group psychoeducation; providing clinician decision support with simplified practice guidelines; and improving access to care, continuity of care, and information flow via nurse care coordinators. In an effectiveness design veterans with bipolar disorder at 11 Veterans Affairs hospitals were randomly assigned to three years of care in the intervention or continued usual care. Blinded clinical and functional measures were obtained every eight weeks. Intention-to-treat analysis (N=306) with mixed-effects models addressed the hypothesis that improvements would accrue over three years, consistent with social learning theory. Results: The intervention significantly reduced weeks in affective episode, primarily mania. Broad-based improvements were demonstrated in social role function, mental quality of life, and treatment satisfaction. Reductions in mean manic and depressive symptoms were not significant. The intervention was cost-neutral while achieving a net reduction of 6.2 weeks in affective episode. Conclusions: Collaborative chronic care models can improve some long-term clinical outcomes for bipolar disorder. Functional and quality-of-life benefits also were demonstrated, with most benefits accruing in years 2 and 3.