A nationwide study on concordance with multimodal treatment guidelines in bipolar disorder

Joannes W. Renes,Willem A. Nolen,Adriaan W. Hoogendoorn,Eline J. Regeer,Ralph W. Kupka

doi:10.1186/s40345-018-0130-z

Abstract

BackgroundMost previous studies on concordance with treatment guidelines for bipolar disorder focused on pharmacotherapy. Few studies have included other treatment modalities.AimsTo study concordance with the Dutch guideline of various treatment modalities in outpatient treatment settings for patients with bipolar disorder and to identity factors associated with concordance.MethodsA nationwide non-interventional study using psychiatrists’ and patients’ surveys.Results839 patients with bipolar or schizoaffective disorder bipolar type were included. Concordance with the guideline was highest for participation of a psychiatrist in the treatment (98%) and for maintenance pharmacotherapy (96%), but lower for supportive treatment (73.5%), use of an emergency plan (70.6%), psychotherapy (52.2%), group psychoeducation (47.2%), and mood monitoring (47%). Presence of a written treatment plan, a more specialized treatment setting, more years of education, and diagnosis of bipolar I disorder versus bipolar II, bipolar NOS, or schizoaffective disorder were significantly associated with better concordance.ConclusionIn contrast to pharmacotherapy, psychosocial treatments are only implemented to a limited extend in everyday clinical practice in bipolar disorder. More effort is needed to implement non-pharmacological guideline recommendations for bipolar disorder.

Highlights

Most previous studies on concordance with treatment guidelines for bipolar disorder focused on pharmacotherapy
In this paper we present the outcomes of a nationwide naturalistic prospective study on treatment practice and concordance with this Dutch guideline in various treatment settings for patients with bipolar disorder (BD) or schizoaffective disorder, bipolar type (SZA)
The model explained almost 10% of variance in concordance scores. In this nationwide study of guideline concordance in routine clinical practice, we found that the use of maintenance pharmacotherapy was highly concordant with the recommendations in the Dutch guideline for BD

Summary

Introduction

Most previous studies on concordance with treatment guidelines for bipolar disorder focused on pharmacotherapy. Few studies have included other treatment modalities, such as psychoeducation or psychotherapy, or visits with health care providers (Busch et al 2007; Farrelly et al 2006; Kilbourne et al 2005; Unutzer et al 2000) In these naturalistic studies on concordance with treatment guidelines, factors that have been found to be of influence are type of mood episode

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Results

Discussion

Conclusion