IMPACT OF AN EASY-ACCESS VA CLINIC-BASED PROGRAM FOR PATIENTS WITH BIPOLAR DISORDER

Objective: The study examined the impact of easy access to ambulatory services for patients with bipolar disorder in a clinic-based program at a Veterans Affairs medical center. Core program components included medication administration based on treatment algorithms, standardized psychoeducation, and easy access to a single primary nurse provider t o enhance continuity of care. The program had no community outreach or extensive rehabilitation components. Methods: The study used a mirror -image design to compare patients' data from the year before program e ntry when patients received standard clinical care with data for the f irst year in the program. Process and outcome data from the first 103 patients to complete one year are reported. Results: The findings indi cated increased patient satisfaction and increased intensity of medica tion treatment without increased side effects at one year. Although sc heduled ambulatory clinic visits increased as expected, use of the eme rgency room and the psychiatric triage team decreased significantly. P atients who were high utilizers of care before program entry experienc ed significant reductions in psychiatric hospital days and total menta l health expenditures. Conclusions: Easy access to ambulatory care, ev en if limited to clinic-based services, may have beneficial effects on important process and outcome measures for bipolar disorder These eff ects may be attributable to on-demand access to services, continuity o f care with a single primary provider, or improved medication delivery to reduce the ''efficacy-effectiveness gap'' for patients with bipola r disorder. Results indicate that augmenting, rather than limiting, ac cess to ambulatory care for patients with major mental illnesses such as bipolar disorder may reduce overall mental health expenditures.