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22-08-2013 | Mental health | Article

Treatment service use disparities found in bipolar patients


Free abstract

medwireNews: A study of healthcare service use by patients with bipolar disorder in the USA has identified clinical and demographic factors that could be used to help optimize patients’ accessibility to services.

The results showed that the patients most likely to underuse services tended to be younger, recent immigrants to the USA, or unemployed, the team reports.

These individuals “could benefit from close monitoring by providers when they do seek services,” say the researchers, led by Louisa Sylvia (Massachusetts General Hospital, Boston, USA), who note that special attention should be paid to “characteristics with low mutability… to ensure that persons have equitable access to health services.”

They also found modifiable characteristics influencing healthcare service use among the 236 bipolar disorder patients, who were analyzed over a 24-week period.

These included more severe bipolar disorder symptoms, notably mania measured on the Young Mania Rating Scale, a 10-unit increase in which resulted in a 48% increase in medical services use. Bipolar disorder symptoms did not affect counseling service use, however.

But, after taking into account clinical and psychologic variables in multivariate analysis, other factors were even more strongly associated with treatment-seeking.

One of the most influential was comorbidity – both psychiatric and medical. Each additional psychiatric condition, notably anxiety disorders, increased the use of all services and counseling services by 25% and 35%, respectively; the association with use of all services remained significant on multivariate analysis.

With regard to medical comorbidities, a high fasting plasma glucose level exceeding 100 mg/dL resulted in double the rate of medical service use, independently increasing the likelihood 2.25-fold, but halved the likelihood for using counseling services.

The fact that individuals with comorbid conditions seek more treatment services, highlights the potential of “coordinated prevention management of bipolar disorder,” say Sylvia and team in Psychiatric Services. This “would likely decrease its financial burden and improve the likelihood of sustained remission,” they explain.

The burden of medication side effects also increased service use, with each unit increase in side-effect intensity and interference increasing the use of all services by 11% and 17%, respectively. High side-effect interference independently increased the likelihood for using all services by 19% and counseling services by 21%.

They hope that their findings “will help providers determine areas of focus in their treatment planning and evaluation,” and “ultimately help to optimize overall outcomes.”

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Lucy Piper, Senior medwireNews Reporter

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