A survey of Saskatchewan family physicians, psychiatrists and pharmacists assessing barriers in lithium use

Abstract

Lithium is a popular mood stabilizer. Anecdotally, it is an underutilized medication in primary care. We conducted a survey of family physicians (FPs), pharmacists and psychiatrists in Saskatchewan to examine attitudes towards and knowledge of lithium use in bipolar disorder (BD). FPs, psychiatrists and pharmacists within Saskatchewan were contacted via email addresses provided by the Saskatchewan Medical Association, Pharmacy Association of Saskatchewan and Canadian Society of Hospital Pharmacists – Saskatchewan Branch and a link to an online survey provided. Responses were obtained from 209 participants – 30 psychiatrists, 103 FPs and 76 pharmacists. Lithium was considered a specialist medication by 63.11% of FPs and 70% of psychiatrists. Lithium was the first choice for maintenance treatment of BD by 31.03% of psychiatrists and 13.68% of FPs, atypical antipsychotics being preferred by both (37.93 and 44.21%, respectively). 72% of the FPs were hesitant to initiate lithium and yet 73.79% felt comfortable monitoring patients already on it. FPs hesitancy could be related to a lack of knowledge in initiating or adjusting lithium doses (53.9%), how the medication works (28.7%), need for blood tests (34.95%), concern about suicidal ideas (11.5%) and the feeling of needing more education on prescribing lithium (79%). 33.69% of FPs were unsure about reference lithium levels or did not use it for monitoring. Limited by small sample size, we observed significant apprehensions about prescribing lithium in this study, more should done in encouraging its use in BD management.