title: Pharmacologic management of bipolar disorder in a Medicare Advantage population.
abstract: OBJECTIVE
  The purpose of this study was to examine patterns of pharmacotherapy for beneficiaries in a high-risk Medicare Advantage program who were diagnosed with bipolar disorder.
  
  
  METHODS
  This was a cross-sectional study of 2338 Medicare Advantage beneficiaries diagnosed with bipolar disorder. Pharmacotherapy treatment was assessed via receipt of (1) a mood stabilizer or antipsychotic or both (i.e., guideline concordant bipolar care) and (2) unopposed antidepressant (i.e., without prescription of a mood stabilizer or an antipsychotic). Logistic regression was used to examine correlates of bipolar disorder care.
  
  
  RESULTS
  Among those younger than 65 years of age (n = 1395), 54% received guideline concordant therapy and 29% received unopposed antidepressant therapy. Among those 65 years and older (n = 943), 40% received guideline concordant therapy and 33% received unopposed antidepressant therapy.
  
  
  CONCLUSIONS
  Overall, about half of beneficiaries in this Medicare Advantage plan received guideline concordant pharmacotherapy for bipolar disorder, while approximately one-third received an unopposed antidepressant prescription. Antipsychotic medications accounted for most of the monotherapy observed. This study identifies opportunities for further improvements in the pharmacotherapy of bipolar disorder in high-risk Medicare patients.
authors.affiliation: Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA (H.H.). Electronic address: hhuang@cha.harvard.edu.
authors.forename: Hsiang
authors.initials: H
authors.lastname: Huang
authors.affiliation: Pharmacy Practice/Clinical Pharmacy/Psychiatry, University of RI/CHA/Harvard, Somerville, MA (J.L.G.).
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Gören
authors.affiliation: Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, WA (J.R., W.K., Y.-F.C., J.U.).
authors.forename: Ya-Fen
authors.initials: YF
authors.lastname: Chan
authors.affiliation: Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, WA (J.R., W.K., Y.-F.C., J.U.).
authors.forename: Wayne
authors.initials: W
authors.lastname: Katon
authors.affiliation: Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, WA (J.R., W.K., Y.-F.C., J.U.).
authors.forename: Joan
authors.initials: J
authors.lastname: Russo
authors.affiliation: Humana Cares, St. Petersburg, FL (D.H.).
authors.forename: Diane
authors.initials: D
authors.lastname: Hogan
authors.affiliation: Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, WA (J.R., W.K., Y.-F.C., J.U.).
authors.forename: Jürgen
authors.initials: J
authors.lastname: Unützer
mesh_terms: D000367:Age Factors; D000368:Aged; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D020398:Medicare Part C / Q000706:statistics & numerical data; D008875:Middle Aged; D014481:United States
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents