International Journal of Clinical Pharmacy

, Volume 39, Issue 4, pp 897–905 | Cite as

A medication assessment tool to evaluate prescribers’ adherence to evidence-based guidelines in bipolar disorder

  • Dalal M. Al-TaweelEmail author
  • Mohammad Alsuwaidan
Research Article


Background The goal of evidence-based clinical practice has led to an increased interest in the development of tools to measure adherence to national guidelines in different diseases. This aids in detecting and measuring inappropriate prescribing to specific patient groups by using quality standards extracted from evidence-based guidelines, and ultimately provide the basis of consistent standardized prescribing. Objective To design and validate a medication assessment tool to assess prescribers’ adherence to international guideline recommendations in the management of bipolar disorder (MATBD). Setting Outpatient psychiatry clinic at a secondary healthcare setting in Kuwait. Method International guidelines concerned with the management of bipolar disorder were reviewed in order to develop MATBD. Face and content validity of the developed tool (MATBD) was performed with a research and expert group. A 4-point Likert scale was used to assess the expert group’s level of agreement to individual criterion. Content validity ratio (CVR) was calculated for each criterion (n = 54) and the content validity index (CVI) was calculated for each section (n = 5) of the MATBD. Finally, feasibility testing was performed on 19 patient records to confirm the tool’s fitness for purpose. Main Outcomes Measure Perceived relevance, utility, and clarity of individual criteria, and reliability of their application to clinical settings. Results Face validity and content validity were achieved with a research and expert group (n = 14). Content validity ratio (CVR) was demonstrated for 54 criteria; criteria with a negative CVR were removed. This resulted in a draft MATBD comprising of 52 criteria (CVI: 0.814). Feasibility testing on 19 patients’ records resulted in a final MATBD comprising of 49 criteria divided into 3 sections: initial assessment, acute management and monitoring. Conclusion A medication assessment tool was developed and validated to be used as a means of profiling potential opportunities for medication therapy management optimization, and improving therapeutic interventions regarding the management of bipolar disorder.


Bipolar disorder Clinical guidelines Guideline adherence Kuwait Medication therapy management 



The authors thank Bashayer Al Khobaizi, BPharm (Ministry of Health, Kuwait) and Zahraa Al Tabtabtaie, BPharm (Ministry of Health, Kuwait) for their assistance in data collection and managing the subjects. Special thanks is due to Shaimaa Abdelmeguid, MSc (Faculty of Pharmacy, Kuwait University) for her technical assistance throughout the study.


This study was funded by Kuwait University, grant number ZP03/14.

Conflicts of interest

All authors declare that they have no conflicts of interest.


  1. 1.
    Department of Health. High quality care for all–NHS Next stage review final report. 2008 UK.Google Scholar
  2. 2.
    President’s advisory commission on consumer protection and quality in the health care industry. Quality first: better health care for all Americans—final report to the President of the United States. 1998 Washington, Government Printing Office.Google Scholar
  3. 3.
    Boland EM, Alloy LB. Sleep disturbance and cognitive deficits in bipolar disorder: toward an integrated examination of disorder maintenance and functional impairment. Clin Psychol Rev. 2013;33:33–44.CrossRefPubMedGoogle Scholar
  4. 4.
    Ösby U, Brandt L, Correia N, Ekbom A, Sparén P. Excess mortality in bipolar and unipolar disorder in Sweden. Arch Gen Psychiatry. 2001;58:844–50.CrossRefPubMedGoogle Scholar
  5. 5.
    Kupfer DJ. The increasing medical burden in bipolar disorder. JAMA. 2005;293:2528–30.CrossRefPubMedGoogle Scholar
  6. 6.
    Kleinman LS, Lowin A, Flood E, Gandhi G, Edgell E, Revicki DA. Costs of bipolar disorder. PharmacoEconomics. 2003;21:601–22.CrossRefPubMedGoogle Scholar
  7. 7.
    Dilsaver SC. An estimate of the minimum economic burden of bipolar I and II disorders in the United States: 2009. J Affect Disord. 2011;129:79–83.CrossRefPubMedGoogle Scholar
  8. 8.
    Wang PS, Lane M, Olfson M, Pincus HA, Wells KB, Kessler RC. Twelve month use of mental health services in the United States. Arch Gen Psychiatry. 2005;62:629–40.CrossRefPubMedGoogle Scholar
  9. 9.
    Dawda Y. Bipolar affective disorder: long-term management.Clinical pharmacist. 2009:73–82.Google Scholar
  10. 10.
    Drayton SJ, Pelic CM. Bipolar Disorder. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, editors. Pharmacotherapy: a pathophysiologic approach, 9e. New York: The McGraw-Hill Companies; 2014. Chapter 52.Google Scholar
  11. 11.
    Kamyar M, Johnson BJ, McAnaw JJ, Lemmens-Gruber R, Hudson SA. Adherence to clinical guidelines in the prevention of coronary heart disease in type II diabetes mellitus. Pharm World Sci. 2008;30:120–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Garcia BH, Utnes J, Naalsund LU, Giverhaug T. MAT-CHDSP, a novel medication assessment tool for evaluation of secondary prevention of coronary heart disease. Pharmacoepidemiol Drug Saf. 2011;20:249–57.CrossRefPubMedGoogle Scholar
  13. 13.
    Hakonsen GD, Hudson S, Loennechen T. Design and validation of a medication assessment tool for cancer pain management. Pharm World Sci. 2006;28:342–51.CrossRefPubMedGoogle Scholar
  14. 14.
    Al-Taweel DM, Awad AI, Johnson BJ. Evaluation of adherence to international guidelines for treating patients with type 2 diabetes mellitus in Kuwait. Int J Clin Pharm. 2013;35:244–50.CrossRefPubMedGoogle Scholar
  15. 15.
    Dennehy EB, Suppes T, Rush AJ, Miller AL, Trivedi MH, Crismon ML, et al. Does provider adherence to a treatment guideline change clinical outcomes for patients with bipolar disorder? Results from the Texas Medication Algorithm Project. Psychol Med. 2005;35:1695–706.Google Scholar
  16. 16.
    Suppes T, Rush AJ, Dennehy EB, Crismon ML, Kashner TM, Toprac MG, et al. Texas Medication Algorithm Project, phase 3 (TMAP-3): clinical results for patients with a history of mania. J Clin Psychiatry. 2003;64:370–82.Google Scholar
  17. 17.
    Wang Z, Gao K, Hong W, Xing M, Wu Z, Chen J, et al. Guidelines disconcordance in acute bipolar depression: data from the National Bipolar Mania Pathway Survey (BIPAS) in mainland China. PLoS ONE. 2014. doi: 10.1371/journal.pone.0096096.
  18. 18.
    Perlis RH. Use of treatment guidelines in clinical decision making in bipolar disorder: a pilot survey of clinicians. Curr Med Res Opin. 2007;23:467–75.CrossRefPubMedGoogle Scholar
  19. 19.
    Divac N, Marić NP, Damjanović A, Jovanović AA, Jašović-Gašić M, Prostran M. Use or underuse of therapeutic guidelines in psychiatry? Psychiatr Danub. 2009;21:224–9.PubMedGoogle Scholar
  20. 20.
    Samalin L, Guillaume S, Auclair C, Llorca P-M. Adherence to guidelines by French psychiatrists in their real world of clinical practice. J Nerv Ment Dis. 2011;199:239–43.CrossRefPubMedGoogle Scholar
  21. 21.
    Paterniti S, Bisserbe JC. Pharmacotherapy for bipolar disorder and concordance with treatment guidelines: survey of a general population sample referred to a tertiary care service. BMC Psychiatr. 2013;13:211.CrossRefGoogle Scholar
  22. 22.
    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 Disord. 2013;15:1–44.Google Scholar
  23. 23.
    National institute for health and care excellence. Bipolar disorder: assessment and management. Clinical guideline [CG185]; 2014; Updated Feb 2016.Google Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Department of Pharmacy Practice, Faculty of PharmacyKuwait UniversityJabriyaKuwait
  2. 2.Faculty of MedicineKuwait UniversityJabriyaKuwait
  3. 3.University of TorontoTorontoCanada

Personalised recommendations