Treatment of bipolar disorder in the Netherlands and concordance with treatment guidelines: study protocol of an observational, longitudinal study on naturalistic treatment of bipolar disorder in everyday clinical practice

BMC Psychiatry, Feb 2014

Background While various guidelines on the treatment of bipolar disorder have been published over the last decades, adherence to guidelines has been reported to be low. In this article we describe the protocol of a nationwide, multicenter, longitudinal, non-intervention study on the treatment of bipolar disorder in the Netherlands. Study aims are to provide information on the nature and content of outpatient treatment of bipolar disorder, to determine to what extent treatment is in concordance with the Dutch guideline for the treatment of bipolar disorder (2008), and to investigate the relationship of guideline concordance with symptomatic and functional outcome. Methods/Design Between December 2009 and February 2010, all psychiatrists registered as member of the Dutch Psychiatric Association received a questionnaire with questions about their treatment setting, and whether they would be willing to participate in further research. Psychiatrists treating adult outpatients with bipolar disorder were invited to participate. Consenting psychiatrist subsequently approached all their patients with bipolar disorder. The study is performed with written patient and caregiver surveys at baseline and after 12 months, including data on demographics, illness characteristics, organization of care, treatments received, symptomatic and functional outcome, quality of life, and burden of care for informal caregivers. Discussion This study will provide information on the naturalistic treatment of bipolar disorder in the Netherlands, as well as degree of concordance of this treatment with the Dutch guideline, and its relationship with symptomatic and functional outcome. Limitations of a survey-based study are discussed.

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Treatment of bipolar disorder in the Netherlands and concordance with treatment guidelines: study protocol of an observational, longitudinal study on naturalistic treatment of bipolar disorder in everyday clinical practice

BMC Psychiatry Treatment of bipolar disorder in the Netherlands and concordance with treatment guidelines: study protocol of an observational, longitudinal study on naturalistic treatment of bipolar disorder in everyday clinical practice Joannes W Renes 0 Eline J Regeer 0 Trijntje YG van der Voort 2 Willem A Nolen 1 Ralph W Kupka 0 2 0 Altrecht Institute for Mental Health Care , Lange Nieuwstraat 119, 3512 PG Utrecht , The Netherlands 1 Department of Psychiatry, University Medical Center, University of Groningen , Hanzeplein 1, 9713 GZ Groningen , The Netherlands 2 Department of Psychiatry, VU University Medical Center , A.J. Ernststraat 1187, 1081 HL Amsterdam , The Netherlands Background: While various guidelines on the treatment of bipolar disorder have been published over the last decades, adherence to guidelines has been reported to be low. In this article we describe the protocol of a nationwide, multicenter, longitudinal, non-intervention study on the treatment of bipolar disorder in the Netherlands. Study aims are to provide information on the nature and content of outpatient treatment of bipolar disorder, to determine to what extent treatment is in concordance with the Dutch guideline for the treatment of bipolar disorder (2008), and to investigate the relationship of guideline concordance with symptomatic and functional outcome. Methods/Design: Between December 2009 and February 2010, all psychiatrists registered as member of the Dutch Psychiatric Association received a questionnaire with questions about their treatment setting, and whether they would be willing to participate in further research. Psychiatrists treating adult outpatients with bipolar disorder were invited to participate. Consenting psychiatrist subsequently approached all their patients with bipolar disorder. The study is performed with written patient and caregiver surveys at baseline and after 12 months, including data on demographics, illness characteristics, organization of care, treatments received, symptomatic and functional outcome, quality of life, and burden of care for informal caregivers. Discussion: This study will provide information on the naturalistic treatment of bipolar disorder in the Netherlands, as well as degree of concordance of this treatment with the Dutch guideline, and its relationship with symptomatic and functional outcome. Limitations of a survey-based study are discussed. Bipolar disorder; Clinical practice; Guidelines; Care as usual - Background Bipolar disorder is a severe mental disorder characterized by recurrent episodes of mania, hypomania, depression, or mixed episodes. The estimated lifetime prevalence of bipolar disorder ranges from 1,5 to 2% [1]. Many patients with bipolar disorder do not regain full psychosocial functioning between episodes and health related quality of life is adversely affected for many patients [2,3]. Although patients themselves are most affected by the illness, informal caregivers also report distress and have difficulties in coping with the illness [4]. To improve quality of care, various guidelines on the treatment of bipolar disorders have been published over the last decades. Recent studies on collaborative care programs for bipolar disorders [5-8] show that patients treated in speciality programs (consisting of an intensive followup by a psychiatric nurse, a psycho-education program, algorithm-based advices on medication treatments for the treating psychiatrist and an emergency plan on how to deal with manic and depressive symptoms) have less manic symptoms and spent less time in manic episodes compared with patient treated with care as usual. Patients also report better quality of life and improved social functioning. Recently, Kessing et al. [9] showed that patients with bipolar disorder in the early course of their illness had a more favorable outcome when treated in a specialized mood disorder clinic versus standard outpatient treatment. As was shown in the Texas Medication Algorithm Project [10] patients with bipolar disorder show a significant improvement in psychiatric symptoms when medication algorithms are implemented in their treatment. It can be assumed that when patients are treated according to guidelines, quality of care as well as treatment outcome will improve. Although little research has been done on adherence to guidelines for the treatment of bipolar disorder in daily practice [11], there is some evidence that without specific interventions adherence to guidelines by care providers is low. Using data from a U.S. medical benefits database, Baldessarini et al. [12] reported that only a quarter of 7760 patients with bipolar disorder in a large community sample was using a mood stabilizer as initial monotherapy. A retrospective study among 1471 bipolar I patients who were discharged from hospital showed that when patients were admitted because of a manic or depressive episode, treatment followed guidelines in patients without psychotic fea (...truncated)


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Joannes W Renes, Eline J Regeer, Trijntje YG van der Voort, Willem A Nolen, Ralph W Kupka. Treatment of bipolar disorder in the Netherlands and concordance with treatment guidelines: study protocol of an observational, longitudinal study on naturalistic treatment of bipolar disorder in everyday clinical practice, BMC Psychiatry, 2014, pp. 58, 14, DOI: 10.1186/1471-244X-14-58