Clinical Outcomes of a Pharmaceutical Care Service in Lithium Clinic adjunct to Standard Care Compared with Standard Care Alone in Patients with Bipolar Disorder: 10 years Naturalistic Retrospective Cohort Study

Orabhorn Suanchang, Vithaya Kulsomboon, Yupadee Sirisinsuk, Norrawee Phoomchan, Charnwit Skawatananont

Abstract


Objective: To compare the long-term clinical outcomes of bipolar patients following lithium maintenance therapy between patients who received standard care plus pharmaceutical care service (lithium clinic group) and patients who received standard care alone (usual care group).
Materials and Methods: This study was a single-center retrospective cohort study. Clinical outcomes were compared between the lithium clinic (n = 120) and usual care groups (n = 240) between January 2006 and December 2015.
Results and discussion: Average study observation time was 6.11+3.14 years. Hospitalization rate due to any recurrence in lithium clinic group (0.0545+0.170 times per year) was significantly less than usual care group (0.1815+0.428 times per year). Also, hospitalization rate from manic recurrence and emergency room visit rate in lithium clinic group (0.0449+0.147 and 0.0286+0.133 times per year, respectively) was significantly lower than usual care group (0.1582+0.392 and 0.1507+0.474 times per year, respectively). Furthermore, lithium clinic group had risk of any recurrence (RR= 0.744, P=0.02), manic recurrence (RR= 0.613, P=0.001) and manic admission (RR= 0.439, P=0.0001) significantly less than usual care group. Median time to manic recurrence was 4.44 (IQR 3.59-5.29) years for lithium clinic group, but 3.54 (IQR 3.08-3.99) years for usual care group. Median time to manic admission was 5.36 (IQR 4.81-5.92) and 3.98 (IQR 3.21-4.76) years for lithium clinic and usual care groups, respectively. Moreover, median time to emergency room visit was 5.36 (IQR 4.93-5.80) years in lithium clinic and 4.09 (IQR 3.46 – 4.72) years in usual care groups.

Conclusion: Lithium clinic group had better long-term clinical outcomes than usual care group. Therefore, pharmaceutical care in bipolar disorder patients is beneficial and should be implemented for other psychiatric hospitals. 


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References


References

Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Beaulieu S, Alda M, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013. Bipolar disorders. 2013;15:1-44.

Soares-Weiser K, Bravo Vergel Y, Beynon S, Dunn G, Barbieri M, Duffy S, et al. A systematic review and economic model of the clinical effectiveness and cost-effectiveness of interventions for preventing relapse in people with bipolar disorder. Health Technology Assessment. 2007;11(39).

Frecska E, Kovacs AI, Balla P, Falussy L, Ferencz A, Varga Z. The message of the survival curves: I. Composite analysis of long-term treatment studies in bipolar disorder. Neuropsychopharmacologia Hungarica : a Magyar Pszichofarmakologiai Egyesulet lapja = official journal of the Hungarian Association of Psychopharmacology. 2012;14(3):155-64.

Cipolle RJ, Strand LM, Morley PC. Pharmaceutical Care Practice. New York: McGraw-Hill 1998.

Canales PL, Dorson PG, ML. C. Outcomes assessment of clinical pharmacy services in a psychiatric inpatient setting. Am J Health-Syst Pharmacy 2001;58:1309-16.

Jenkins MH, Bond CA. The impact of clinical pharmacists on psychiatric patients. Pharmacotherapy. 1996;16(4):708-14.

Canales PL, Dorson PG, Crismon ML. Outcomes assessment of clinical pharmacy services in a psychiatric inpatient setting. Am J Health Syst Pharm. 2001;58(14):1309-16.

Virani A, Crown N. The Impact of a Clinical Pharmacist on Patient and Economic Outcomes in a Child and Adolescent Mental Health Unit. Can J Hosp Pharm 2003;56:158-62.

Fieve RR. The Lithium Clinic: A New Model for the Delivery of Psychiatric Services. Am J Psychiatry. 1975;32(10):1018-22.

Pakes GE. Our pharmacy department offers 8 services in a lithium clinic for manic-depressives. Pharm Times. 1980;46(9):38-42.

Lee S. The first lithium clinic in Hong Kong: a Chinese profile. Aust N Z J Psychiatry. 1992;26(3):450-3.

Courtney ME, Acomb JA, Lovatt V. A pharmacy-controlled lithium clinic. Psychiatr Bull 1995;19(1):15-7.

Maj M, Pirozzi R, Magliano L, Bartoli L. Long-term outcome of lithium prophylaxis in bipolar disorder: a 5-year prospective study of 402 patients at a lithium clinic. Am J Psychiatry. 1998;155(1):30-5.

Schweitzer I, Davies B, Burrows G, Branton L, Turecek LR, Tiller J. The Royal Melbourne Hospital Lithium Clinic. Aust N Z J Psychiatry. 1999;33 Suppl:S35-8.

Licht RW, Vestergaard P, Rasmussen NA, Jepsen K, Brodersen A, Hansen PE. A lithium clinic for bipolar patients: 2-year outcome of the first 148 patients. Acta psychiatrica Scandinavica. 2001;104(5):387-90.

Shaw M. The role of lithium clinics in the treatment of bipolar disorder. Nursing Times. 2004;100(27):42-6.

Suanchang O, Suthisisang C, Visanuyothin T, Skawatananont C. Development and evaluation of a pharmaceutical care process in patients with bipolar disorder at outpatient lithium clinic of Somdet Chaopraya Hospital. Bangkok: Mahidol University; 2002.


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