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OBJECTIVES Persons with bipolar disorder experience a disproportionate burden of medical conditions, notably cardiovascular disease (CVD), leading to impaired functioning and premature mortality. We hypothesized that the Life Goals Collaborative Care (LGCC) intervention, compared to enhanced usual care, would reduce CVD risk factors and improve physical and(More)
OBJECTIVES Comorbid medical conditions, notably cardiovascular disease, occur disproportionately among persons with bipolar disorder; yet the quality and outcomes of medical care for these individuals are suboptimal. This pilot study examined a bipolar disorder medical care model (BCM) and determined whether, compared with usual care, individuals randomly(More)
The authors determined whether diagnoses of cardiovascular disease (CVD) and CVD-related conditions differed by psychiatric diagnosis among male Veterans Administration patients from the mid-Atlantic region. Among 7,529 patients (mean age: 54.5 years), the prevalence of diagnoses ranged from 3.6% (stroke) to 35.4% (hypertension). Compared with schizophrenia(More)
OBJECTIVE Depression is a major contributor to death and disability, but few follow-up studies of depression have been carried out in the primary-care setting. The authors sought to assess whether depression in older patients is associated with increased mortality after a 2-year follow-up interval and to estimate the population-attributable fraction (PAF)(More)
OBJECTIVE Depression treatment in primary care elderly patients has been inadequate, resulting in low rates of response and remission. The authors compared treatment remission rates and time-to-remission of elderly subjects enrolled in two ongoing depression treatment studies, one in primary care practices ("PROSPECT") and the other in an academic tertiary(More)
BACKGROUND Evidence-based quality improvement models for depression have not been fully implemented in routine primary care settings. To date, few studies have examined the organizational factors associated with depression management in real-world primary care practice. To successfully implement quality improvement models for depression, there must be a(More)
OBJECTIVES We compared perceived access to and satisfaction with health care between patients diagnosed with serious mental illness (SMI: schizophrenia or bipolar disorder) and among those with no SMI diagnosis. METHOD We conducted a national, cross-sectional study of VA patients in Fiscal Year (FY) 1999 (N = 7,187) who completed the VA's Large Health(More)
The Veterans Health Administration (VHA) is the largest integrated health care system in the United States, serving more than 8 million veterans. VHA is currently undergoing extensive changes to its health care delivery model, moving toward the full implementation of the patient-centered medical home. Mental health providers, including psychologists working(More)
OBJECTIVES To investigate the association between anticonvulsant use and fracture risk among older patients, including those with bipolar disorder (BD), an indicated condition for treatment with this class of medications. DESIGN A prospective cohort study with 4.5 years of follow-up analyzed using both Cox proportional hazards modeling and propensity(More)
The authors discuss a system that describes the resources needed to treat different subgroups of the population under age 65, based on burden of disease. It is based on 173 conditions, each with up to 3 severity levels, and contains models that combine prospective diagnoses with retrospectively determined elements. We used data from four different payers(More)