Design and implementation of a randomized trial evaluating systematic care for bipolar disorder.
Design and implementation of a randomized trial evaluating systematic care for bipolar disorder.
复制标题
设计和实施评估双相情感障碍系统护理的随机试验。
DOI：
10.1034/j.1399-5618.2002.01190.x
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发表时间：
2002
影响因子：
5.4
通讯作者：
Bauer,MarkS
中科院分区：
文献类型：
--
作者：
Simon,GregoryE;Ludman,Evette;Unützer,Jürgen;Bauer,MarkS
目标：双相情感障碍的日常护理通常缺乏循证实践。本报告描述了一项随机试验的设计和实施，该试验评估了一项系统计划，以提高双相情感障碍护理的质量和连续性。方法：使用大型健康计划的计算机记录来识别所有接受双相情感障碍治疗的患者。经过基线诊断评估后，合格且同意的患者被随机分配到继续常规护理或多方面干预计划，包括：制定协作治疗计划、由专门的护理经理每月进行电话监测、监测结果反馈和基于算法的药物治疗建议给治疗心理健康提供者、按需外展和护理协调以及结构化的心理教育小组计划 （鲍尔和麦克布莱德的生活目标计划）由护士护理经理提供。每 3 个月对临床结果、功能结果和治疗过程进行盲法评估，持续 24 个月。结果：共有 441 名患者（符合资格的患者的 64%）同意参与，43% 的入组患者符合当前重性抑郁发作、躁狂发作或轻躁狂发作的标准。另外 39% 的人报告有明显的阈下症状，18% 的人报告目前情绪症状轻微或没有。在分配到干预计划的患者中，94% 的患者参与了电话监测，70% 的患者至少参加了一次小组会议。结论：在接受双相情感障碍治疗的基于人群的患者样本中，大约三分之二同意参加一项比较替代治疗策略的随机试验。几乎所有患者都接受定期电话监测，超过三分之二的患者参加了结构化小组计划。未来的报告将描述干预计划与常规护理相比的临床有效性和成本效益。
Objectives:Everyday care of bipolar disorder typically falls short of evidence‐based practice. This report describes the design and implementation of a randomized trial evaluating a systematic program to improve quality and continuity of care for bipolar disorder.Methods:Computerized records of a large health plan were used to identify all patients treated for bipolar disorder. Following a baseline diagnostic assessment, eligible and consenting patients were randomly assigned to either continued usual care or a multifaceted intervention program including: development of a collaborative treatment plan, monthly telephone monitoring by a dedicated nurse care manager, feedback of monitoring results and algorithm‐based medication recommendations to treating mental health providers, as‐needed outreach and care coordination, and a structured psychoeducational group program (the Life Goals Program by Bauer and McBride) delivered by the nurse care manager. Blinded assessments of clinical outcomes, functional outcomes, and treatment process were conducted every 3 months for 24 months.Results:A total of 441 patients (64% of those eligible) consented to participate and 43% of enrolled patients met criteria for current major depressive episode, manic episode, or hypomanic episode. An additional 39% reported significant subthreshold symptoms, and 18% reported minimal or no current mood symptoms. Of patients assigned to the intervention program, 94% participated in telephone monitoring and 70% attended at least one group session.Conclusions:In a population‐based sample of patients treated for bipolar disorder, approximately two‐thirds agreed to participate in a randomized trial comparing alternative treatment strategies. Nearly all patients accepted regular telephone monitoring and over two‐thirds joined a structured group program. Future reports will describe clinical effectiveness and cost‐effectiveness of the intervention program compared with usual care.