Use of a point-of-care web-based application to enhance adherence to the CANMAT and ISBD 2018 guidelines for the management of bipolar disorder

Does the Ranking Matter? A Retrospective Cohort Study Investigating the Impact of the 2018 CANMAT and ISBD Guidelines for the Management of Patients with Bipolar Disorder Treatment Recommendations for Acute Mania on Rehospitalization Rates

OBJECTIVE

There is limited data about the impact of mood disorders treatment guidelines on clinical outcomes. The objective of this study was to investigate the impact of prescribers' adherence to the 2018 Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) treatment guidelines recommendations on the readmission rates of patients hospitalized for mania.

METHOD

A retrospective cohort of all individuals admitted due to acute mania to Kingston General Hospital, Kingston, ON, from January 2018 to July 2021 was included in this study. Patient variables and data regarding index admission and subsequent hospitalizations were extracted from medical records up to December 31, 2021. Treatment regimens were classified as first-line, second-line, noncompliant, or no treatment. We explored the associations between treatment regimens and the risk of readmissions using univariate, multivariate, and survival analysis.

RESULTS

We identified 211 hospitalizations related to 165 patients. The mean time-to-readmission was 211.8 days (standard deviation [SD]  =  247.1); the 30-day rehospitalization rate was 13.7%, and any rehospitalization rate was 40.3%. Compared to no treatment, only first-line treatments were associated with a statistically significant decreased risk of 30-day readmission (odds ratio [OR] = 0.209; 95% CI, 0.058 to 0.670). The risk of any readmission was reduced by first-line (OR = 0.387; 95% CI, 0.173 to 0.848) and noncompliant regimens (OR = 0.414; 95% CI, 0.174 to 0.982) compared to no treatment. On survival analysis, no treatment group was associated with shorter time-to-readmission (log-rank test, p  =  0.014) and increased risk of readmission (hazard ratio = 2.27; 95% CI, 1.30 to 3.96) when compared to first-line medications.

CONCLUSIONS

Treatment with first-line medications was associated with lower 30-day rehospitalization rates and longer time-to-readmission. Physicians' adherence to treatments with higher-ranked evidence for efficacy, safety, and tolerability may improve bipolar disorder outcomes.

Barriers to timely identification of bipolar disorder in youth: a multidimensional perspective

Bipolar disorder (BD) in youth often goes unrecognized and therefore untreated. However, little is known about pathways to treatment of youth with BD and factors that influence the time taken for each stage of these pathways. In this article, we use the conceptual framework by Scott and colleagues called the Model of Pathways to Treatment as a foundation to explore the components of delay in the diagnosis and treatment of youth with BD. The total time from the onset of symptoms until treatment initiation was divided into four sequential intervals; i.e., the Appraisal, the Help-seeking, the Diagnostic and the Pre-treatment intervals and potential disease, patient, and healthcare system/provider factors that influence each interval were identified. This multidimensional conceptual framework can offer a systematic approach to understanding and exploring barriers to early identification and interventions in BD, which is a crucial step in the development of strategies to facilitate prompt diagnosis and treatment. We hope this work contributes to the discussion on delayed diagnosis and treatment of youth with BD and provides a roadmap to inform future research studies and policy decisions.