Provider Interventions

Specific provider interventions in bipolar disorder have not been reported. In a pilot study we have just completed (Parikh et al., unpublished), we created a "bipolar treatment optimization program" that incorporated a patient intervention and a simultaneous provider education and support intervention for the patient's primary care physician. Patients benefited, but it is too early to determine to what extent the provider intervention was effective.

However, the larger context of medical care, and depression in particular, has been studied exhaustively with respect to provider interventions, such as providing education in the form of treatment guidelines, continuing medical education events, and providing feedback of screening tools such as depression self-report scales routinely administered to all patients in a practice setting. From medicine as a whole, traditional education in the form of conventional continuing medical education events, distribution and teaching of guidelines, grand rounds, and conferences have shown little impact on clinical practice (Davis et al., 1995; 1999). As summarized by Von Korff and Goldberg (2001), randomized, controlled trials of interventions to improve depression treatment in primary care have been negative when the intervention focused only on provider or provider plus patient interventions. In the same spirit, single-session training events in depression did not change practice patterns, but there is evidence that longitudinal programs alter practice (Hodges et al., 2001; Parikh et al., 1999). However, simple mass screening with rating scales and provision of results to the relevant primary-care physician have not been found particularly effective in altering disease outcomes (Gilbody et al., 2001). Taken together and extrapolated, these findings suggest that provider interventions may be a necessary, but are clearly not a sufficient, intervention to make an improvement in the treatment of bipolar disorder.

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