Tuesday, April 15, 2014

Bipolar Disorder Patients in Integrated Primary Care May Need More-Intensive Services, Study Shows

Primary care patients with bipolar disorder enrolled in an integrated care system in Washington state may require more intensive services than currently provided in a collaborative care model, according to a study, “Bipolar Disorder in Primary Care: Clinical Characteristics of 740 Primary Care Patients With Bipolar Disorder,” which is published online today in Psychiatric Services.

Researchers from the University of Washington identified 740 primary care patients with bipolar disorder in the statewide mental health integration program (MHIP) between January 2008 and December 2011 using the Composite International Diagnostic Interview and clinician diagnosis. The MHIP uses collaborative care based on the IMPACT model (Improving Mood–Promoting Access to Collaborative Treatment) to improve recognition and systematic treatment of patients with psychiatric disorders in primary care settings.

Primary care patients with bipolar disorder had high symptom severity on both depression and anxiety measures using the Patient Health Questionnaire and the Generalized Anxiety Disorder scale. Psychosocial problems were common, with approximately 53% reporting concerns about housing, 15% reporting homelessness, and 22% reporting lack of a support person. Yet only 26% of patients were referred to specialty mental health treatment.

Study co-author Wayne Katon, M.D. (photo above), vice chair of the Department of Psychiatry at the University of Washington, said that the study indicates that these patients may need more-intensive care than is currently provided in a collaborative care model, in which a care manager, supervised by a psychiatrist, provides the direct patient care. “The importance of this article is that the U.S. federally qualified primary care clinics, as well as many primary care clinics that treat both uninsured and Medicaid patients, are likely to have a significant percentage of patients with bipolar illness, especially bipolar 2 illness,” Katon told Psychiatric News. “This article emphasizes that despite the fact that only about one-third improve with treatment in these clinics, few are being referred to community mental health clinics or actually attend when referred. These clinics already had integrated collaborative care—that is, the use of a care manager supervised by a psychiatrist—so the inference is that these patients may need more-intensive psychiatric treatment, which could occur if psychiatrists are integrated into the clinics either in person or via telemedicine. Alternatively, the clinics need to establish better links with community mental health.”

To read more about integrated and collaborative care, see the Psychiatric News article by Katon, "Three Decades of Working in Integrated Care."


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