Concordance with treatment guidelines for bipolar disorder: data from the systematic treatment enhancement program for bipolar disorder.
Concordance with treatment guidelines for bipolar disorder: data from the systematic treatment enhancement program for bipolar disorder.
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发表时间：
2007
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通讯作者：
E. Dennehy;M. Bauer;R. Perlis;Jane Kogan;G. Sachs
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作者：
E. Dennehy;M. Bauer;R. Perlis;Jane Kogan;G. Sachs
慢性精神障碍的治疗与循证指南的一致性通常很低。该研究评估了双相情感障碍系统性治疗增强计划（STEP-BD）中已发表的双相情感障碍治疗指南建议的一致性程度。研究了依从性的潜在人口统计学和临床预测因素。方法STEP-BD治疗精神科医生参加了广泛的循证药理学管理培训，重点是已发表的临床实践指南。每种特定情绪发作的推荐药物和剂量是从已发表的治疗指南中提取的，并合并为综合指南。然后将前瞻性观察到的新发情绪发作（抑郁、混合或轻躁狂/躁狂）患者首次访视时的处方药物信息与指南建议进行比较。目前的研究包括964例STEP-BD患者，观察超过2年，他们经历了前瞻性观察的发作（n = 716抑郁; n = 182轻躁狂/躁狂; n = 66混合）。在81.8%的混合发作、81.9%的轻躁狂/躁狂发作和83.4%的抑郁发作中规定了指南一致性治疗，超过了先前在指南实施的随机对照试验中报告的比率。年轻的发病年龄和接受充分的药物治疗的STEP-BD入口预测那些更有可能接受指南一致的护理。结论：使用指南一致的药物治疗大大高于自然条件下的报告。我们推测，基本的提供者教育加上药物选择的合作方法可能有助于在这个大型国家试验中的高治疗一致率。与其他研究一样，很少有患者特异性因素与接受指南一致性治疗的可能性相关。
BACKGROUND Concordance with evidence-based guidelines in the treatment of chronic mental disorders is typically low. The study assesses the degree of concordance to recommendations of published treatment guidelines for bipolar disorder in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Potential demographic and clinical predictors of adherence were examined. METHODS STEP-BD treating psychiatrists participated in extensive training in evidence-based pharmacological management focusing on published clinical practice guidelines. Recommended medications and dosing for each specific mood episode were extracted from published treatment guidelines and collapsed into a Composite guideline. Prescribed medication information for patients at the first visit in a prospectively observed new-onset mood episode (depressive, mixed, or hypomanic/manic) was then compared with guideline recommendations. RESULTS The current study included 964 STEP-BD patients, observed over 2 years, who experienced a prospectively observed episode (n = 716 depressive; n = 182 hypomanic/ manic; n = 66 mixed). Guideline concordant treatments were prescribed in 81.8% of mixed episodes, 81.9% of hypomanic/manic episodes, and 83.4% of depressive episodes, exceeding rates previously reported in randomized controlled trials of guideline implementation. Younger age of onset and receipt of adequate pharmacotherapy at STEP-BD entry predicted those more likely to receive guideline-concordant care. CONCLUSIONS The use of guideline concordant pharmacological treatments was substantially higher than reported under naturalistic conditions. We speculate that basic provider education plus a collaborative approach to medication choice may have contributed to the high treatment concordance rates in this large national trial. As in other studies, few patient-specific factors were associated with the likelihood of receiving guideline-concordant care.