Integrating Bipolar Disorder Management in Primary Care
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There is growing realization that persons with bipolar disorder may exclusively be seen in primary (general medical) care settings, notably because of limited access to mental health care and stigma in seeking mental health treatment. At least two clinical practice guidelines for bipolar disorder recommend collaborative chronic care models (CCMs) to help integrate mental health care to better manage this illness. CCMs, which include provider guideline support, self-management support, care management, and measurement-based care, are well-established in primary care settings, and may help primary care practitioners manage bipolar disorder. However, further research is required to adapt CCMs to support complexities in diagnosing persons with bipolar disorder, and integrate decision-making processes regarding medication safety and tolerability in primary care. Additional implementation studies are also needed to adapt CCMs for persons with bipolar disorder in primary care, especially those seen in smaller practices with limited infrastructure and access to mental health care.
KeywordsBipolar disorder Mood disorder Co-occurring conditions Primary care Integrated care Collaborative care Chronic Care Model CCM Screening Diagnosis Treatment Access Mental health services Psychiatry
This work was supported by the Department of Veterans Affairs, Veterans Health Administration, Clinical Sciences Research and Development [CSRD S06], the VA Health Services Research and Development Center for Organization, Leadership, and Management Research (COLMR), the National Institute of Mental Health [RO1 MH 79994 and R01 74509] and the University of Michigan Comprehensive Depression Center (Director’s Innovation Fund). The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.
A.M. Kilbourne is the author of the workbook Overcoming Bipolar Disorder: A Comprehensive Workbook for Managing Your Symptoms & Achieving Your Life Goals (New Harbinger Publications, Inc., 2008), which was the basis for many of the current study interventions cited and for which she receives royalties; D.E. Goodrich: none; A.N. O’Donnell: none; CJ. Miller: none.
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