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Systemic challenges in bipolar disorder management: A patient‐centered approach
Author(s) -
Nestsiarovich Anastasiya,
Hurwitz Nathaniel G,
Nelson Stuart J,
Crisanti Annette S,
Kerner Berit,
Kuntz Matt J,
Smith Alicia N,
Volesky Emma,
Schroeter Quentin L,
DeShaw Jason L,
Young S Stanley,
Obenchain Robert L,
Krall Ronald L,
Jordan Kimmie,
Fawcett Jan,
Tohen Mauricio,
Perkins Douglas J,
Lambert Christophe G
Publication year - 2017
Publication title -
bipolar disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.285
H-Index - 129
eISSN - 1399-5618
pISSN - 1398-5647
DOI - 10.1111/bdi.12547
Subject(s) - bipolar disorder , multidisciplinary approach , observational study , mental health , focus group , psychology , scale (ratio) , dilemma , medicine , psychiatry , cognition , political science , physics , epistemology , marketing , philosophy , quantum mechanics , law , business
Objectives As part of a series of Patient‐Centered Outcomes Research Institute‐funded large‐scale retrospective observational studies on bipolar disorder ( BD ) treatments and outcomes, we sought the input of patients with BD and their family members to develop research questions. We aimed to identify systemic root causes of patient‐reported challenges with BD management in order to guide subsequent studies and initiatives. Methods Three focus groups were conducted where patients and their family members (total n = 34) formulated questions around the central theme, “What do you wish you had known in advance or over the course of treatment for BD ?” In an affinity mapping exercise, participants clustered their questions and ranked the resulting categories by importance. The research team and members of our patient partner advisory council further rated the questions by expected impact on patients. Using a Theory of Constraints systems thinking approach, several causal models of BD management challenges and their potential solution were developed with patients using the focus group data. Results A total of 369 research questions were mapped to 33 categories revealing 10 broad themes. The top priorities for patient stakeholders involved pharmacotherapy and treatment alternatives. Analysis of causal relationships underlying 47 patient concerns revealed two core conflicts: for patients, whether or not to take pharmacotherapy, and for mental health services, the dilemma of care quality vs quantity. Conclusions To alleviate the core conflicts identified, BD management requires a coordinated multidisciplinary approach including: improved access to mental health services, objective diagnostics, sufficient provider visit time, evidence‐based individualized treatment, and psychosocial support.