Extra input pays bipolar treatment dividends

By Eleanor McDermid, Senior medwireNews Reporter

Customizing an implementation program to individual practices and providing proactive support improves the adherence of patients with bipolar disorder to Life Goals Collaborative Care (LGCC), shows a randomized trial.

Researcher Amy Kilbourne (University of Michigan Medical School, Ann Arbor, USA) and team say that the level of adherence achieved “was similar to estimates reported in previous randomized controlled trials in more tightly controlled clinical settings.”

And they add: “[F]uture research should consider whether the added costs of facilitation can be absorbed by health care organizations because they contribute to the overall cost-efficiency of delivering effective psychosocial treatments in routine practice.”

The standard version of the intervention, called Replicating Effective Programs (REP), included a program outline, a treatment manual, and a guide to implementation. Staff received training and had access to as-needed technical support.

The enhanced version began with a needs assessment, resulting in each practice receiving a customized version of the implementation. In addition, a nominated staff member at each practice worked closely with an external facilitator to set implementation goals and identify and overcome organizational barriers.

This approach resulted in significantly improved adherence, the team reports in Psychiatric Services. The 117 patients attending the three practices that were randomly assigned to receive enhanced REP achieved an average of 8.1 contacts (self-management group sessions and care-management contacts), compared with 5.5 for the 140 patients at the two practices assigned to standard REP.

This significant difference was driven by an increased number of care-management contacts, at 5.0 versus 2.6.

“Often the hardest component to maintain, care management is a crucial component of LGCC and similar chronic care models because it facilitates assessment of clinical status over time and encourages positive changes in health behavior,” comment Kilbourne et al.

After accounting for confounders, patients attending the enhanced REP practices were a significant 7.2 times more likely to achieve the minimum necessary adherence (at least three self-management and four care-management contacts). And they were 22.3 times more likely to achieve optimal adherence (all four self-management and at least six care-management contacts).

“Enhanced REP might have improved sustainability of care management because the external and internal facilitators were able to help the health specialists to secure the resources required for group sessions and provider follow-up,” say the researchers.

They add that further customization of REP may be needed to improve adherence of groups such as women and homeless people, who had significantly reduced adherence in the current study.

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