Collaborative Care for Bipolar Disorder: Part II. Impact on Clinical Outcome, Function, and Costs

Bauer, Mark S.; McBride, Linda; Williford, William O.; Glick, Henry A.; Kinosian, Bruce; Altshuler, Lori L.; Beresford, Thomas P.; Kilbourne, Amy M.; Sajatovic, Martha; Brown, George R.; Eilers, Steven G.; Evans, Denise; Fenn, Howard H.; Hauger, Richard; Kirk, Gail; Mayeda, Aimee R.; Tekell, Janet L.; Akiskal, Hagop S.; Collins, Joseph F.; Biswas, Kousick; Staves, Pamela J.; Lavori, Philip W.

doi:10.1176/appi.focus.130114

Cited by 27 publications

(51 citation statements)

References 62 publications

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“…Clinical procedures are based on the Life Goals Collaborative Care Program, a bipolar CCM [28][29][30] that is guideline endorsed 31,32 and listed on the Substance Abuse and Mental Health Administration's National Registry of Evidence-Based Programs and Practices (www.samhsa.gov/nrepp). Core components, delivered via CVT, include the following:…”

Section: Program Descriptionmentioning

confidence: 99%

“…Literature review revealed that adoption rates compared favorably with that of a CVT depression care management intervention in community-based clinics, 5 and rates of participation in Life Goals modules resembled rates seen in clinical trials of on-site delivery. [28][29][30] A recent qualitative implementation analysis of depression care management in an HIV population similarly identified care management and integration of consultation into the electronic health record as facilitators, while difficulty in incorporating depression case-finding into routine work-flow was a barrier. 38 Generalizable lessons learned.…”

Section: Key Findings In Contextmentioning

confidence: 99%

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Implementing and Sustaining Team-Based Telecare for Bipolar Disorder: Lessons Learned from a Model-Guided, Mixed Methods Analysis

Bauer

Krawczyk

Tuozzo

et al. 2018

Telemedicine and e-Health

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Background: Telemental health interventions have empirical support from clinical trials and structured demonstration projects. However, their implementation and sustainability under less structured clinical conditions are not well demonstrated. Introduction: We conducted a follow-up analysis of the implementation and sustainability of a clinical video teleconferencebased collaborative care model for individuals with bipolar disorder treated in the Department of Veterans Affairs to (a) characterize the extent of implementation and sustainability of the program after its establishment and (b) identify barriers and facilitators to implementation and sustainability. Materials and Methods: We conducted a mixed methods program evaluation, assessing quantitative aspects of implementation according to the Reach, Efficacy, Adoption, Implementation, and Maintenance implementation framework. We conducted qualitative analysis of semistructured interviews with 16 of the providers who submitted consults, utilizing the Integrated Promoting Action on Research Implementation in the Health Services implementation framework. Results: The program demonstrated linear growth in sites (n = 35) and consults (n = 915) from late 2011 through mid-

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Section: Program Descriptionmentioning

confidence: 99%

Section: Key Findings In Contextmentioning

confidence: 99%

Implementing and Sustaining Team-Based Telecare for Bipolar Disorder: Lessons Learned from a Model-Guided, Mixed Methods Analysis

Bauer

Krawczyk

Tuozzo

et al. 2018

Telemedicine and e-Health

Self Cite

View full text Add to dashboard Cite

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“…Importantly, these studies were done in managed health-care cooperatives in the USA and included large patient samples with systematic follow-up. In trials at a group health cooperative (n=441) 82 and in 11 Veterans Administration sites (n=306), 83 patients were randomly assigned to systematic care or usual care. Although neither study showed reductions in relapses, patients in systematic care had fewer weeks in manic episodes than did those in usual care.…”

Section: Systematic Care Managementmentioning

confidence: 99%

“…Cost-effectiveness analyses suggested that the care programmes saved money despite their greater intensity of follow-up. 82,83 …”

Section: Systematic Care Managementmentioning

confidence: 99%

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The Treatment of Bipolar Disorder

Möller¹,

Nasrallah²

2017

Oxford Medicine Online

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We review recent developments in the acute and long-term treatment of bipolar disorder and identify promising future routes to therapeutic innovation. Overall, advances in drug treatment remain quite modest. Antipsychotic drugs are effective in the acute treatment of mania; their efficacy in the treatment of depression is variable with the clearest evidence for quetiapine. Despite their widespread use, considerable uncertainty and controversy remains about the use of antidepressant drugs in the management of depressive episodes. Lithium has the strongest evidence for long-term relapse prevention; the evidence for anticonvulsants such as divalproex and lamotrigine is less robust and there is much uncertainty about the longer term benefits of antipsychotics. Substantial progress has been made in the development and assessment of adjunctive psychosocial interventions. Long-term maintenance and possibly acute stabilisation of depression can be enhanced by the combination of psychosocial treatments with drugs. The development of future treatments should consider both the neurobiological and psychosocial mechanisms underlying the disorder. We should continue to repurpose treatments and to recognise the role of serendipity. We should also investigate optimum combinations of pharmacological and psychotherapeutic treatments at different stages of the illness. Clarification of the mechanisms by which different treatments affect sleep and circadian rhythms and their relation with daily mood fluctuations is likely to help with the treatment selection for individual patients. To be economically viable, existing psychotherapy protocols need to be made briefer and more efficient for improved scalability and sustainability in widespread implementation.

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Integrated and Collaborative Care

et al. 2021

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Many patients with HIV receive care for neuropsychiatric disorders in HIV primary care clinics. This is at least partially due to a shortage of mental health specialists, which leads to long wait times and inadequate continuity of care. Stigma of mental illness can also be a major barrier to people seeking psychiatric care in mental health settings. In people with HIV, the stigma of mental illness is compounded by that of having HIV. Patients frequently fear discrimination and rejection and may avoid leaving HIV primary care settings to seek treatment in other settings. As a consequence, there is a need to provide psychiatric care in a setting that is accessible to, acceptable to, and supportive of the patient. Such a need also offers a tremendous opportunity to provide integrated biopsychosocial approaches to treat the whole patient with HIV.There are several integrated care models by which psychiatric care can be provided to patients with HIV. Integrated models of care for HIV psychiatry refer to a psychiatrist specializing in HIV psychiatry working closely with patients and other physicians to provide coordinated care for complex patients with HIV. Rarely is any model implemented in "complete" form. Rather, implementing integrated care involves local adaptations, based on availability of clinical resources, acceptability in existing clinic culture, and additions of clinical resources to address gaps in treatment. Integration occurs on a continuum, often starting with small changes and building on gains. Successful integration efforts capitalize on the strengths of team members and structure, occur in stages, and allow for revision based on feedback from clinicians and patients. Maintaining a dialogue among those who are developing and are impacted by integrated care programs is essential. Input from all stakeholders impacted by healthcare integration is important to make the organizational changes necessary to properly implement an integrated care system.Telepsychiatry is a useful technology to improve patients' access to psychiatric care and can be leveraged in any of the integrated care models [5]. It can enhance communication among clinical team members working at different sites. It can also be used to provide education and "curbside consultation" to HIV clinicians.In this chapter, we describe four models of integrated care that can be applied to HIV psychiatry: the consultation and referral model, the co-located model, the patient-centered medical home (PCMH), and the collaborative care model. Within our discussion of collaborative care, we describe key components, summarize the evidence base for collaborative care, list roles of key members of the collaborative care team, and identify essential areas of workforce training. We detail a systematic approach to screening, diagnosis, treatment, and monitoring. Some of the complexities of providing collaborative care for HIV, including stigma, isolation, and high rates of neuropsychiatric comorbidities, will be illustrated via patient cases.

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Collaborative Care for Bipolar Disorder: Part II. Impact on Clinical Outcome, Function, and Costs

Cited by 27 publications

References 62 publications

Implementing and Sustaining Team-Based Telecare for Bipolar Disorder: Lessons Learned from a Model-Guided, Mixed Methods Analysis

Implementing and Sustaining Team-Based Telecare for Bipolar Disorder: Lessons Learned from a Model-Guided, Mixed Methods Analysis

The Treatment of Bipolar Disorder

Integrated and Collaborative Care

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