Bipolar disorder measurement-based care: Two-phase trial in primary care

To assess feasibility and preliminary effectiveness of measurement-based care (MBC) for bipolar disorder.

We recruited adults with bipolar disorder in community primary care clinics with integrated mental health services. We used the Patient Mania Questionnaire-9 (PMQ-9, manic symptoms) and Patient Health Questionnaire-9 (PHQ-9, depressive symptoms) for MBC. In the lead-in phase, a fidelity score assessed adherence to MBC. In the randomization phase, patients were randomized to 6 months of MBC or usual care. The primary outcome was number of treatment changes. Baseline and 6-month participant surveys assessed other outcomes. We used a Mann-Whitney U test and descriptive statistics.

In the lead-in phase, five psychiatrists and fifteen patients participated, with symptom measures completed at all participant visits (n = 40 visits). In the randomization phase, all invited psychiatrists (n = 6) and psychiatric advanced practice registered nurses (n = 3) participated. Thirty patients were consented and randomized. There was no statistically significant difference in the number of treatment changes between groups (Med_MBC = 3, IQR 3; Med_usual = 2, IQR 4.5;). No symptom severity or quality of life change score differences were statistically different; however, improvement exceeded minimal detectable difference only in MBC from baseline to six months on PHQ-9(MΔ_MBC = -4.64; SD = 7.77, MΔ_usual = -1.25; SD = 4.16) and PMQ-9 (MΔ_MBC = -2.93; SD = 5.89, MΔ_usual = -0.92; SD = 3.03). Baseline to 6-month quality of life scores improved in both arms.

Given the feasibility and preliminary effectiveness of MBC for bipolar disorder in primary care, a larger fully powered trial should test if MBC yields greater reduction in symptoms and increased quality of life.