Use of treatment guidelines in clinical decision making in bipolar disorder: a pilot survey of clinicians.
OBJECTIVE
With recent attention to the importance of evidence-based medicine in psychiatry, a number of treatment guidelines have emerged to aid clinicians in clinical decision making. The objective of this study was to assess the extent to which such guidelines are used in the treatment of bipolar disorder.


METHODS
In November 2005, self-administered questionnaires were sent to 7000 psychiatrists who treat bipolar disorder in their clinical practice. An additional mailing of these questionnaires was done in January 2006 to a different group of 7000 psychiatrists who also treat bipolar disorder in their clinical practice. The first 312 completed surveys were analyzed. Eight questions relevant to clinical usage of, and attitudes toward, existing guidelines were asked.


RESULTS
Among the 312 respondents, 64.1% reported making routine use of treatment guidelines when making clinical decisions, including 19.6% who used the American Psychiatric Association treatment guidelines and 33.0% who used all published guidelines. Of those who did not use bipolar guidelines, the most frequently cited reason given by respondents (20.1%) was that such guidelines do not address particular features of their clinical populations. Among the different types of practice, private individual practice gave this answer most frequently (27.5%).


CONCLUSIONS
These results suggest that, despite considerable efforts to develop and disseminate evidence-based guidelines, they are not widely implemented and substantial opportunities exist to educate clinicians about their value and relevance. Limitations of the study include a low response rate and possible selection bias. Nonetheless, this project was conceived of as a pilot study and these limitations do not negate the findings, but suggest other avenues for investigation.
Perlis
Roy H
RH
Depression and Bipolar Clinical and Research Programs, Massachusetts General Hospital, Boston, MA 02114, USA. rperlis@partners.org
D000328:Adult; D018692:Antimanic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000175:diagnosis / Q000188:drug therapy*; D003657:Decision Making; D019317:Evidence-Based Medicine / Q000592:standards / Q000639:trends; D005260:Female; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D018020:Lithium Compounds / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000639:trends; D011570:Psychiatry / Q000592:standards / Q000639:trends; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States
D018692:Antimanic Agents; D018020:Lithium Compounds