SEATTLE — For patients with bipolar disorder, medication management appears to work as well with primary care clinicians supported by psychiatrists as direct psychiatrist care.
An article in General Hospital Psychiatry compared medication treatment of individuals with bipolar disorder in two primary care-based integrated care models. The VA Puget Sound Healthcare System in Seattle participated in the study led by the University of Washington.1
For the study participants were randomized to 12 months of treatment with direct care by co-located psychiatrists in primary care, or collaborative care, defined as primary care clinicians supported by psychiatrists. The research team extracted medication data at initial and last treatment visits from the clinical registry for 191 patients diagnosed with bipolar disorder.
Results indicated that study participants receiving no medication treatment decreased from 28% to 11% (direct co-located) (χ2 = 10.9, p < 0.001) and 39% to 17% (collaborative care; χ2 = 16.9, p < 0.001).
“Last visit medication prescriptions for antipsychotic medication (approximately one-half of participants) increased significantly compared to initial visit and did not differ between arms,” the researchers wrote. “Anticonvulsant mood-stabilizing medication (approximately one-third of participants in both arms) was higher than lithium prescription (approximately 6% of participants) at last visit.”
The authors concluded that “similar patterns of medication treatment were observed in participants with bipolar disorder receiving either direct care from psychiatrists, or medication treatment by primary care clinicians supported by psychiatrists.”
- Cerimele JM, Johnson M, Blanchard BE, Russo J, Unützer J, Fortney JC. Bipolar disorder in primary care: Medication treatment by co-located psychiatrists versus primary care clinicians supported by psychiatrists. Gen Hosp Psychiatry. 2022 Aug 4;78:108-110. doi: 10.1016/j.genhosppsych.2022.08.001. Epub ahead of print. PMID: 35985201.