More Than Half of Primary Care Physicians "Unprepared" to Manage Bipolar Disorder

Fran Lowry

June 21, 2010

June 21, 2010 (Boca Raton, Florida) — Primary care physicians report that they do not feel competent to diagnose bipolar disorder or manage a treatment plan for patients with the disease, according to new research presented here at the New Clinical Drug Evaluation Unit (NCDEU) 50th Anniversary Meeting.

The finding underscores the need for primary care physicians to receive additional education about bipolar disorder, reported lead study author, Jennifer L. Payne, MD, from Johns Hopkins University School of Medicine, Baltimore, Maryland, and her associate, Purvi K. Smith, MS, MPH, from Health and Wellness Education Partners, in Ramsey, New Jersey.

"Unfortunately, bipolar disorder is often misdiagnosed or underdiagnosed in primary care. These patients are falling through the cracks," Ms. Smith told Medscape Medical News in an interview at her poster. "We were trying to understand what the factors related to this were and also how primary care physicians would self-rank themselves if they were given a list of 6 competencies."

To this end, the researchers mailed a survey to a random sample of 900 family physicians from the circulation of the Journal of Family Practice. The survey recipients were asked about the prevalence of mood symptoms among their patients, as well as their extent of preparedness in 6 clinical competencies related to bipolar disorder diagnosis, evaluation, and treatment.

The physicians were asked about how competent they felt about:

  • Assessing the patient for bipolar disorder using interviewing techniques or a screening tool;

  • Reviewing with patients the comorbidities associated with bipolar disorder;

  • Evaluating a patient's phase, whether manic or depressive;

  • Communicating the psychotherapy for bipolar disorder;

  • Communicating the pharmacotherapy for bipolar disorder; and

  • Developing a treatment plan.

The 69 primary care physicians who answered the survey reported that an average of 23% of their patients commonly experience mood symptoms.

Regardless of the number of years in practice or the type of practice setting, 36 of 69 family physicians surveyed (52.2%) indicated that they were "underprepared" to assess a patient for bipolar disorder using screening tools, to review the comorbid conditions associated with bipolar disorder with the patient, to determine the phase of the disorder based on symptom presentation, to develop a treatment plan, and to communicate the pharmacologic and psychotherapeutic treatment options to the patient.

Ms. Smith told Medscape Medical News that the study generated a lot of interest among NCDEU meeting attendees.

"We've spoken to a lot of psychiatrists here about the importance of partnering with their peers in primary care to improve health outcomes," she said. "A lot of people are agreeing that this is a huge area of need."

Psychiatrist Michael R. Ware, MD, from the Department of Community Health and Family Medicine at the University of Florida in Gainesville, agrees.

"Given that mood disorders, including major depression and bipolar disorder, are commonly seen by family physicians in their outpatient settings, this study underscores the need to better educate them about the differential diagnosis and treatment of common mood disorders found in their patients."

This study was funded by Eli Lilly. Ms. Smith and Dr. Ware have disclosed no relevant financial relationships.

New Clinical Drug Evaluation Unit (NCDEU) 50th Anniversary Meeting: Abstract 4, Session II. Presented June 16, 2010.

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