Does guideline-concordant care predict naturalistic outcomes in youth with early stage bipolar I disorder?

Adolescent Bipolar Disorder / diagnosis Humans Prospective Studies Severity of Illness Index Surveys and Questionnaires Treatment Outcome
Bipolar disorder Concordance Early stage Guidelines Mania Treatment

Journal

Journal of affective disorders
ISSN: 1573-2517
Titre abrégé: J Affect Disord
Pays: Netherlands
ID NLM: 7906073

Informations de publication

Date de publication:
01 01 2021
Historique:
received: 05 05 2020
revised: 04 08 2020
accepted: 04 09 2020
pubmed: 20 9 2020
medline: 20 4 2021
entrez: 19 9 2020
Statut: ppublish

Résumé

The impact of guideline concordance on naturalistic maintenance treatment outcomes in BD is not known. We sought to evaluate the effect of guideline-concordant care on symptomatic, course and functional outcomes in youth with early-stage BD-I. In this file audit study, we examined the prospective course of 64 clients with first treatment seeking manic episode of BD-I. Eighteen-month outcome measures included Clinical Global Impressions Scale - Bipolar Version (CGI-BP), Social and Occupational Functioning Assessment Scale (SOFAS) and number of relapses. Correlations and hierarchical linear regressions were used to examine the relationships between guideline concordance and outcomes, while controlling for potential confounders. Although higher guideline-concordant care in the maintenance phase was associated with a higher discharge CGI-BP score and thus worse outcome, baseline CGI-BP and insight were more predictive of illness severity at follow-up than guideline concordance. There was no association with SOFAS and guideline-concordant care at follow-up. Greater concordance with maintenance medication guideline statements was also associated with greater number of relapses even after controlling for sex, medication adherence, duration of care and baseline illness severity. This study was limited by sample size and its single pool of clients which may limit generalizability. Contrary to our hypotheses, higher guideline concordance was associated with worse outcomes, although this relationship was moderated by the client's illness characteristics, severity and insight. More unwell youth with poor insight, greater severity, and mixed/rapid cycling features may need other interventions or modified guidelines.

Sections du résumé

BACKGROUND
The impact of guideline concordance on naturalistic maintenance treatment outcomes in BD is not known. We sought to evaluate the effect of guideline-concordant care on symptomatic, course and functional outcomes in youth with early-stage BD-I.
METHODS
In this file audit study, we examined the prospective course of 64 clients with first treatment seeking manic episode of BD-I. Eighteen-month outcome measures included Clinical Global Impressions Scale - Bipolar Version (CGI-BP), Social and Occupational Functioning Assessment Scale (SOFAS) and number of relapses. Correlations and hierarchical linear regressions were used to examine the relationships between guideline concordance and outcomes, while controlling for potential confounders.
RESULTS
Although higher guideline-concordant care in the maintenance phase was associated with a higher discharge CGI-BP score and thus worse outcome, baseline CGI-BP and insight were more predictive of illness severity at follow-up than guideline concordance. There was no association with SOFAS and guideline-concordant care at follow-up. Greater concordance with maintenance medication guideline statements was also associated with greater number of relapses even after controlling for sex, medication adherence, duration of care and baseline illness severity.
LIMITATIONS
This study was limited by sample size and its single pool of clients which may limit generalizability.
CONCLUSIONS
Contrary to our hypotheses, higher guideline concordance was associated with worse outcomes, although this relationship was moderated by the client's illness characteristics, severity and insight. More unwell youth with poor insight, greater severity, and mixed/rapid cycling features may need other interventions or modified guidelines.

Identifiants

DOI: 10.1016/j.jad.2020.09.037 PMID: 32949870
pubmed: 32949870
pii: S0165-0327(20)32732-4
doi: 10.1016/j.jad.2020.09.037
pii:
doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

23-32

Informations de copyright

Copyright © 2020 Elsevier B.V. All rights reserved.

Auteurs

Priya Sunder (P)

Orygen, Parkville, Australia; Melbourne Medical School, University of Melbourne, Parkville, Australia.

Ming-Fang Chia (MF)

Orygen, Parkville, Australia; Melbourne Medical School, University of Melbourne, Parkville, Australia.

Kate Filia (K)

Orygen, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia.

Craig Macneil (C)

Orygen, Parkville, Australia.

Melissa Hasty (M)

Orygen, Parkville, Australia.

Christopher Davey (C)

Orygen, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia.

Patrick McGorry (P)

Orygen, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia.

Michael Berk (M)

Orygen, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia; Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Geelong, Australia; Florey Institute of Neuroscience and Mental Health, Parkville, Australia.

Sue Cotton (S)

Orygen, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia.

Aswin Ratheesh (A)

Orygen, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia. Electronic address: aswinr@unimelb.edu.au.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female

Evaluation of Low-Value Services Across Major Medicare Advantage Insurers and Traditional Medicare.

Ciara Duggan, Adam L Beckman, Ishani Ganguli et al.
1.00
Humans United States Aged Cross-Sectional Studies Medicare Part C

Effectiveness of Virtual Yoga for Chronic Low Back Pain: A Randomized Clinical Trial.

Hallie Tankha, Devyn Gaskins, Amanda Shallcross et al.
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adolescent › Does guideline-concordant care predict...
questionsmedicales.fr › Troubles mentaux › Troubles de l'humeur › Troubles bipolaires et apparentés › Trouble bipolaire › Does guideline-concordant care predict...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Does guideline-concordant care predict...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études prospectives › Does guideline-concordant care predict...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Enquêtes et questionnaires › Enquêtes de santé › Indicateurs d'état de santé › Acuité des besoins du patient › Indice de gravité de la maladie › Does guideline-concordant care predict...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Enquêtes et questionnaires › Does guideline-concordant care predict...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Résultat thérapeutique › Does guideline-concordant care predict...