Randomized controlled trial of a health plan-level mood disorders psychosocial intervention for solo or small practices

Background: Mood disorders represent the most expensive mental disorders for employer-based commercial health plans. Collaborative care models are effective in treating chronic physical and mental illnesses at little to no net healthcare cost, but to date have primarily been implemented by larger healthcare organizations in facility-based models. The majority of practices providing commercially insured care are far too small to implement such models. Health plan-level collaborative care treatment can address this unmet need. The goal of this study is to implement at the national commercial health plan level a collaborative care model to improve outcomes for persons with mood disorders. Methods/Design A randomized controlled trial of a collaborative care model versus usual care will be conducted among beneficiaries of a large national health plan from across the country seen by primary care or behavioral health practices. At discharge 344 patients identified by health plan claims as hospitalized for unipolar depression or bipolar disorder will be randomized to receive collaborative care (patient phone-based self-management support, care management, and guideline dissemination to practices delivered by a plan-level care manager) or usual care from their provider. Primary outcomes are changes in mood symptoms and mental health-related quality of life at 12 months. Secondary outcomes include rehospitalization, receipt of guideline-concordant care, and work productivity. Discussion This study will determine whether a collaborative care model for mood disorders delivered at the national health plan level improves outcomes compared to usual care, and will inform a business case for collaborative care models for these settings that can reach patients wherever they receive treatment. Trial registration ClinicalTrials.gov Identifier: NCT02041962; registered January 3, 2014

Raw data <i>Tenebrio molitor</i>, raw data_<i>Monochamus alternatus</i>, raw data_<i>Allomyrina dichotoma</i>.

Raw data Tenebrio molitor, raw data_Monochamus alternatus, raw data_Allomyrina dichotoma.</p

Survival curves of <i>Allomyrina dichotoma</i> exposed <i>Beauveria bassiana</i> AAD16 and ARP14.

Survival curves of Allomyrina dichotoma exposed Beauveria bassiana AAD16 and ARP14.</p

Molecular phylogenetic analysis of <i>Beauveria bassiana</i> AAD16 with similar strain and other genera based on nucleotide sequence and constructed by maximum likelihood method.

Molecular phylogenetic analysis of Beauveria bassiana AAD16 with similar strain and other genera based on nucleotide sequence and constructed by maximum likelihood method.</p

Efficacy of <i>Beauveria bassiana</i> AAD16 and ARP14 strains on mealworm (<i>Tenebrio molitor</i>) larvae in the size of (A)16-18 and (B) 22–24 mm over time.

The * above bars indicate significant differences among the treatments (Tukey studentized range HSD test, α = 0.05).</p

Calculation of LT₅₀ values for <i>A</i>. <i>dichotoma</i>.

A strain (AAD16) of the entomopathogenic fungus Beauveria bassiana (Balsamo) Vuillemin was isolated from field-collected Japanese rhinoceros beetle, Allomyrina dichotoma (L.) (Coleoptera: Scarabaeidae). Its virulence was compared with another strain (ARP14) recovered from a cadaver of Riptortus pedestris (F.) (Hemiptera: Alydidae) focusing on its effect on three coleopteran, i.e., Tenebrio molitor L., A. dichotoma, and Monochamus alternatus Hope. The LT50 value of T. molitor for two larval sizes, i.e., 16–18 and 22–24 mm, was 15.3 and 19.4% lower for strain AAD16 compared to strain ARP14, respectively. Furthermore, after 8 and 10 days of exposure, the mycosis rate of strain AAD16 was 1.3 and 1.2 times higher than that of strain ARP14 in the 16–18 and 22–24 mm larval sizes, respectively. The LT50 for M. alternatus larvae was 23.2% lower on strain AAD16 than on strain ARP14. In addition, the LT50 for M. alternatus adults was 47.1% lower for strain AAD16 compared to control. The mycosis rate of strain AAD16 on M. alternatus larvae was 1.8 higher than that of strain ARP14 after 120 hours of exposure. The strain AAD16 also showed higher larval mortality (90%) for A. dichotoma compared to strain ARP14 (45.0%) at 28 days after exposure. These results suggest that B. bassiana AAD16 can be a potential biological control agent against coleopteran pests.</div

Mycosis rate of <i>Beauveria bassiana</i> AAD16 and ARP14 strains on 14 days old long horned beetle (<i>M</i>. <i>alternatus</i>) larvae.

The * above the data point in line graph indicate significant differences among the treatments (Tukey studentized range HSD test, α = 0.05).</p

Calculation of LT₅₀ values for 14-d-old long horned beetle (<i>Monochamus alternatus</i>).

Calculation of LT50 values for 14-d-old long horned beetle (Monochamus alternatus).</p

Mycosis rate (%) of <i>Beauveria bassiana</i> AAD16 and ARP14 strains on mealworm (<i>T</i>. <i>molitor</i>) larvae in the size of (A) 16–18 and (B) 22–24 mm.

The * above the data point in line graph indicate significant differences among the treatments (Tukey studentized range HSD test, α = 0.05).</p