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
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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)