Kilbourne Amy M, Biswas Kousick, Pirraglia Paul A, Sajatovic Martha, Williford William O, Bauer Mark S
VA Ann Arbor Serious Mental Illness Treatment Research and Evaluation Center and Department of Psychiatry, University of Michigan; Ann Arbor, MI 48105, USA.
J Affect Disord. 2009 Jan;112(1-3):256-61. doi: 10.1016/j.jad.2008.04.010. Epub 2008 May 27.
The effectiveness of bipolar collaborative chronic care models (B-CCMs) among those with co-occurring substance use, psychiatric, and/or medical conditions has not specifically been assessed. We assessed whether B-CCM effects are equivalent comparing those with and without co-occurring conditions.
We reanalyzed data from the VA Cooperative Study #430 (n=290), an 11-site randomized controlled trial of the B-CCM compared to usual care. Moderators included common co-occurring conditions observed in patients with bipolar disorder, including substance use disorders (SUD), anxiety, psychosis; medical comorbidities (total number), and cardiovascular disease-related conditions (CVD). Mixed-effects regression models were used to determine interactive effects between moderators and 3-year primary outcomes.
Treatment effects were comparable for those with and without co-occurring substance use and psychiatric conditions, although possibly less effective in improving physical quality of life in those with CVD-related conditions (Beta=-6.11;p=0.04).
Limitations included multiple comparisons and underpowered analyses of moderator effects.
B-CCM effects were comparable in patients with co-occurring conditions, indicating that the intervention may be generally applied. Specific attention to physical quality of life in those with CVD maybe warranted.
双相情感障碍协作式慢性照护模式（B-CCMs）在同时患有物质使用障碍、精神疾病和/或躯体疾病的患者中的有效性尚未得到专门评估。我们比较了有和没有共病情况的患者，评估B-CCM的效果是否等同。
我们重新分析了退伍军人事务部合作研究#430（n = 290）的数据，这是一项在11个地点进行的随机对照试验，将B-CCM与常规护理进行比较。调节因素包括双相情感障碍患者中常见的共病情况，包括物质使用障碍（SUD）、焦虑症、精神病；躯体合并症（总数）以及心血管疾病相关情况（CVD）。使用混合效应回归模型来确定调节因素与3年主要结局之间的交互作用。
有和没有共病物质使用和精神疾病的患者的治疗效果相当，尽管对患有心血管疾病相关情况的患者改善身体生活质量的效果可能较差（β=-6.11；p = 0.04）。
局限性包括多重比较以及对调节因素效应的功效不足分析。
B-CCM在有共病情况的患者中的效果相当，表明该干预措施可能普遍适用。可能需要特别关注患有心血管疾病患者的身体生活质量。
