Electronic Pathway On Improving Management of Bipolar Disorder for Adults in Secondary Care; From Ivory Tower to Frontline Delivery.

Abstract

Introduction; Health practitioners are familiar with the challenge of linking academic knowledge to naturalistic treatment settings. For years unexplained and unacceptable variations of practice have plagued service delivery. The National Institute for Health and Care Excellence (NICE) set to address this situation by providing guidance on effective interventions. However the actual uptake of NICE standards remains poor (Variations in Health Care The good, the bad and the inexplicable, the King's Fund 2011). Methods; Cheshire and Wirral Partnership NHS Foundation Trust (CWP) resolved on the use of clinical pathways integrated to the patient electronic system to promote and measure evidence based practice. NICE standards on Bipolar Disorder ( www.nice.org.uk/cg038 ) were integrated to this assistive technology. The differential concordance to the NICE audit criteria was measured between two similar community teams, one using the Bipolar electronic Integrated Care Pathway (eICP) and the other providing treatment as usual (TAU). Outcome measures were taken in 2010 and repeated in 2014. Results; The average concordance with NICE standards is markedly higher for the team using the eICP, as measured in the baseline audit in 2010 and replicated in the re-audit in 2014. Conclusion The Bipolar eICP delivers reliable concordance to evidence based standards of good practice and facilitates the audit process. The outcomes have been consistent over time. It has proven to be flexible as used by various practitioners as well as being a vector of education. The Bipolar eICP stands as a low cost alternative to specialist teams in the effective management of Bipolar Disorder.