Clinical characteristics and resource utilization of patients with bipolar disorder who have frequent psychiatric interventions

Abstract

Objective:

To compare the demographics, clinical characteristics and resource utilization of patients with bipolar disorder who required frequent psychiatric interventions (FPIs) with those needing fewer interventions in the Duke Healthcare System database between 1999 and 2005.

Methods:

This retrospective analysis was conducted using electronic medical records of bipolar patients with FPIs, defined as having ≥4 clinically significant events (CSEs) in any 12-month period while in the Duke University Healthcare System. CSEs were composed of emergency room visits, inpatient hospitalizations, or a change in psychotropic medication due to psychiatric symptoms (score ≥4 on the Clinical Global Impressions–Severity scale). Data were compared between patients with and without FPIs.

Results:

Of 632 patients with bipolar disorder 52.5% were identified as having FPIs. These patients were younger and more often female and African American than those with fewer interventions (p < 0.01 for all). Patients with FPIs were generally prescribed more psychotropic and non-psychotropic medications, utilized more healthcare resources and experienced more psychiatric co-morbidities than those who did not require FPIs (p < 0.01 for all).

Limitations:

These results are from a single healthcare system and may not be generalizable to all patients with bipolar disorder. This analysis was retrospective and relied on availability of adequate information recording and coding of diagnoses by physicians.

Conclusions:

Patients with bipolar disorder who required FPIs were significantly different from those with fewer clinically defined interventions with respect to their demographic and clinical characteristics and prescribed medications.

Key words::

• Bipolar disorder
• Clinical management research information system
• Clinically significant events
• Frequent psychiatric interventions

Transparency

Declaration of funding:

This analysis was supported by funding from Ortho-McNeil Janssen Scientific Affairs, LLC, Titusville, NJ, USA. Duke University Behavioral Health Informatics was contracted by Johnson & Johnson Pharmaceutical Services, LLC, to access and analyze the data provided in this manuscript.

Declaration of financial/other relationships:

J.T.H. is a full-time employee of Johnson & Johnson Pharmaceutical Research and Development, LLC, and a Johnson & Johnson stockholder. N.T., C.C., R.D. and L.A. have disclosed that they are full-time employees of Ortho-McNeil Janssen Scientific Affairs, LLC, and Johnson & Johnson stockholders. W.M. has disclosed that at the time of this analysis he was a full-time employee of Ortho-McNeil Janssen Scientific Affairs, LLC. B.B. and K.G. have disclosed that they have no conflicts of interest to report.

Acknowledgments:

The authors wish to acknowledge the writing and editing assistance provided by Matthew Grzywacz, PhD, and ApotheCom (funding supported by Ortho-McNeil Janssen Scientific Affairs, LLC) in the development and submission of this manuscript. The authors also wish to acknowledge Earle Bain, MD, for his significant contributions to the early stages of this work. Dr Bain is a former employee of Ortho-McNeil Janssen Scientific Affairs, LLC, and is currently an employee of Abbott Laboratories, Inc.

The study data have been presented at the following congresses:

Society of Biological Psychiatry Annual Meeting, May 17–19, 2007, San Diego, CA; International Conference on Bipolar Disorder, June 7–9, 2007, Pittsburgh, PA; US Psychiatry and Mental Health Congress Annual Meeting, October 11–14, 2007, Orlando, FL; Institute on Psychiatric Services Annual Meeting, October 2--5, 2008, Chicago, IL, USA.