Bipolar disorder in primary care: Medication treatment by co-located psychiatrists versus primary care clinicians supported by psychiatrists

Abstract

Objective: To compare medication treatment of individuals with bipolar disorder in two primary care-based integrated care models.

Methods: Participants were randomized to 12-months of treatment with direct care by co-located psychiatrists in primary care, or collaborative care (primary care clinicians supported by psychiatrists). Medication data at initial and last treatment visits were extracted from the clinical registry for 191 patients diagnosed with bipolar disorder.

Results: Participants receiving no medication treatment decreased from 28% to 11% (direct co-located) (χ² = 10.9, p < .001) and 39% to 17% (collaborative care; χ² = 16.9, p < .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. Anticonvulsant mood-stabilizing medication (approximately one-third of participants in both arms) was higher than lithium prescription (approximately 6% of participants) at last visit.

Conclusion: 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.

Keywords: Bipolar disorder; Collaborative care; Medication; Primary care; Telepsychiatry.