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May 3, 2005

Community Intervention for BP?

Population-based care for Bipolar Disorder

This is an article that is a preliminary report from a large trial that is looking to see if a community based intervention has a positive impact on the lives of people with bipolar disorder. Specifically, the authors of the study have set up a program in which people are randomly assigned either to the group that receives special attention from a psychiatric nurse/case manager or a group that receives the regular treatment and follow-up from the clinic. Both groups are allowed to be on whatever medication regimen is needed and receive a full treatment regimen, but the group that receives the intervention has an extra bit of help in maintaining appointments, reminders about medication and symptom surveillance.

The authors calculated that to show a 15% improvement they would need to have 250 people in both groups. They were able to recruit 500 subjects and over 400 joined the study and were randomized (assigned randomly) to one group or the other. The study is to last for 24 months; however this report is of the first 12 month’s worth of data.

The authors found that as of the first 12 months, there was not a lot of difference between the groups. The number of emergency room visits, hospital days and adherence to medication regimen was statistically even between the groups though there was a trend towards less hospital usage in the group with the extra intervention. The authors point out though that hospitalizations are uncommon and therefore would require either a longer duration of study or greater number of patients to show a statistical difference and so perhaps at the 24 month end point of the study there may be a measurable difference. The cost of the extra intervention was $512/subject and so would cost less than viruatlly any hospitalization. This is important because if in fact the data ultimately shows a benefit with respect to hospitalizations the intervention will save money in the long run as well as improve quality of life. The only statically significant differences between the groups were in the number of medication management visits and in the number of patients who were on atypical antipsychotics (also useful for anti-mania properties in bipolar disorder.) The extra intervention group was higher in both of those categories than the standard treatment group. There was also a significantly different decrease in the amount of mania symptoms experienced by the group who received the extra intervention so it remains to be seen how that will impact the ultimate utilization of resources. However, at the very least that should indicate an improvement in quality of life and decreased risk of a full blown manic episode which can be potentially life altering.

As this is preliminary data, it will be interesting to see how the study turns out upon its completion. The authors point out that bipolar disorder is a complicated disorder that does not always follow a predictable timeline. Long term data is scant in bipolar disorder so hopefully this NIMH funded study will be able to provide some answers that will help improve symptoms and decrease hospitalizations. However, for right now, the data does not show a definite improvement with this intervention.

Funded by grant R01 MH59125 from the National Institute of Mental Health. The funding agency provided consultation regarding study design, but was not involved in data collection, data analysis and interpretation, or preparation of this manuscript.

Simon GE, Ludman EJ, Unutzer J, Bauer MS, Operskalski B, Rutter C.
Randomized trial of a population-based care program for people with bipolar disorder.
Psychol Med. 2005 Jan;35(1):13-24.

Click here for this article on PubMed

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