Bipolar disorder center for Pennsylvanians: implementing an effectiveness trial to improve treatment for at-risk patients.
OBJECTIVE
Adolescents, elderly persons, African Americans, and rural residents with bipolar disorder are less likely than their middle-aged, white, urban counterparts to be diagnosed, receive adequate treatment, remain in treatment once identified, and have positive outcomes. The Bipolar Disorder Center for Pennsylvanians (BDCP) study was designed to address these disparities. This report highlights the methods used to recruit, screen, and enroll a cohort of difficult-to-recruit individuals with bipolar disorder.


METHODS
Study sites included three specialty clinics for bipolar disorder in a university setting and a rural behavioral health clinic. Study operations were standardized, and all study personnel were trained in study procedures. Several strategies were used for recruitment.


RESULTS
It was possible to introduce the identical assessment and screening protocol in settings regardless of whether they had a history of implementing research protocols. This protocol was also able to be used across the age spectrum, in urban and rural areas, and in a racially diverse cohort of participants. Across the four sites 515 individuals with bipolar disorder were enrolled as a result of these methods (69 African Americans and 446 non-African Americans). Although clinical characteristics at study entry did not differ appreciably between African Americans and non-African Americans, the pathways into treatment differed significantly.


CONCLUSIONS
Rigorous recruitment and assessment procedures can be successfully introduced in different settings and with different patient cohorts, thus facilitating access to high-quality treatment for individuals who frequently do not receive appropriate care for bipolar disorder.
Kupfer
David J
DJ
Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara St., Pittsburgh, PA 15213, USA. kupferdj@upmc.edu
Axelson
David A
DA
Birmaher
Boris
B
Brown
Charlotte
C
Curet
David E
DE
Fagiolini
Andrea
A
Frank
Ellen
E
Friedman
Edward S
ES
Grochocinski
Victoria J
VJ
Houck
Patricia R
PR
Kilbourne
Amy M
AM
Mulsant
Benoit H
BH
Pollock
Bruce G
BG
Reynolds
Charles F
CF
Stofko
Mary G
MG
Swartz
Holly A
HA
Thase
Michael E
ME
Turkin
Scott R
SR
Whyte
Ellen M
EM
D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000523:psychology*; D000368:Aged; D000465:Algorithms; D001714:Bipolar Disorder / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003155:Community Mental Health Centers / Q000458:organization & administration*; D019468:Disease Management; D005260:Female; D006284:Health Plan Implementation / Q000458:organization & administration; D054625:Healthcare Disparities; D006801:Humans; D007318:Inservice Training / Q000458:organization & administration; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009720:Nurse Clinicians; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011619:Psychotropic Drugs / Q000008:administration & dosage / Q000627:therapeutic use; D012424:Rural Population; D055502:Secondary Prevention; D055815:Young Adult
D011619:Psychotropic Drugs