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The Effects of an Ambulatory Collaborative Practice Model on Process and Outcome of Care for Bipolar Disorder

Department of Veterans Affairs Medical Center, 116A2, Providence, RI 02908-4799.

Linda McBride, RN, MSN

Veteran University School of Medicine in Providence, Rhode Island.

Christopher Gavin, BA

Veteran Affairs Medical Center in Providence, Rhode Island.

Mark S. Bauer, MD

Veteran Affairs Medical Center in Providence, Rhode Island; Department of Psychiatry; Brown University School of Medicine in Providence, Rhode Island.

BACKGROUND: Bipolar disorder is a chronic mental illness that affects 1% of the population. Persons with bipolar disorder have substantial rehabilitative potential although research has shown that such mood disorders are undertreated.

OBJECTIVES: The objective was to determine the effect of a high-intensity collaborative practice ambulatory program on process and outcome of care: specifically, patient satisfaction, intensity of medication treatment, and the amount and patterns of service use.

STUDY DESIGN: The Bipolar Disorders Program was structured for easy patient access by assigning clinical nurse specialists as primary caregivers to each patient supported by psychiatrist backup. The first 76 patients enrolled in the Bipolar Disorders Program who completed 6 months served as the sample. A quasiexperimental study was used. A mirror image design was used where relevant measurements before admission to the Bipolar Disorders Program were compared with data during the first 6 months of enrollment.

RESULTS: Patients showed significant increases in satisfaction with care, increases in intensity of medication treatment, and trends toward decreases in neuroleptic exposure. Annualized service use data revealed significant decreases in emergency department use, psychiatric triage use, and psychiatric hospitalization days.

CONCLUSIONS: These data indicated that high-intensity ambulatory treatment for bipolar disorder may have increased both treatment intensity and patient satisfaction and decreased use of costly mental health services.

Journal of the American Psychiatric Nurses Association, Vol. 3, No. 2, 49-57 (1997)
DOI: 10.1177/107839039700300205


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