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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n\u003Cp id=\u0022p-1\u0022\u003EAlthough algorithmic approaches to the pharmacological treatment of general medical conditions are not new, very little data has been gathered on the use of this approach in psychiatric conditions. This article discusses data evaluating physician adherence to treatment guidelines for the pharmacological management of bipolar disorder, before and after a training program geared towards increasing compliance to those guidelines.\u003C\/p\u003E\n\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EPsychopharmacology Guidelines\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EAlthough algorithmic approaches to the pharmacological treatment of general medical conditions are not new, very little data has been gathered on the use of this approach in psychiatric conditions. At this years APA meeting, Thomas Smith, MD, Columbia University, presented data evaluating physician adherence to treatment guidelines for the pharmacological management of bipolar disorder, before and after a training program geared towards increasing compliance to those guidelines. Evidence suggests that the pharmacological treatment of bipolar disorder is highly variable, based on individual psychiatrists\u0027 predilections for certain medications, often yielding poor outcomes.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003ESmith notes, \u201cOur goal was to use a combination of didactic training and individualized feedback with data to effect change in practice patterns.\u201d In Phase 1 of this study, clinical raters evaluated the medical records of 23 bipolar patients who had resided, at one point in time, in an acute psychiatric inpatient unit. These patients were treated by 4 psychiatrists. In order to complete a reliable and valid assessment, a rating tool was developed that would assess which medication was chosen for the treatment of bipolar disorder. Medications were either rated as either \u201cFirst-\u201d or \u201cSecond-line\u201d options based on the Expert Consensus Treatment Guidelines for Bipolar Disorder (Keck, PE, Perlis, RH, Otto, MW, Carpenter, D, Ross, R, Doherty, JP. \u003Cem\u003EPostgrad Med Special Report\u003C\/em\u003E 2004, Dec: 1\u2013120).\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EAt the initial rating, approximately 52% of the cases reviewed showed that the clinician followed the guidelines for the treatment of bipolar disorder. Under the sub-category of \u201cbipolar-depressed\u201d, adherence rates dropped to approximately 39%. No statistical comparison was reported. It was suggested that these adherence rate differences are indicative of the difficult nature of treating bipolar-depressed patients with pharmacological agents (Sach S, Koslow CL, Ghaemi SN. \u003Cem\u003EBipolar Disord\u003C\/em\u003E 2000. 2:256\u201360).\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EFollowing the evaluation of pharmacological management of bipolar disorder in these records, training on the guidelines, set forth by the above mentioned treatment guidelines, was provided to a subset of the psychiatrists from the initial sample. The training included discussion-based groups as well as a review of specific cases with the psychiatrist of record.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EAfter this training was completed, 6 months were allowed to pass before 16 new cases were evaluated for adherence rates to the Expert Consensus Treatment Guidelines for Bipolar Disorder (2004). At this time, adherence rates for the general bipolar population rose to approximately 63% (constituting an 11% increase). For the subgroup of bipolar-depressed patients, adherence rate increased to 73% (constituting a 34% increase).\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EDr. Smith concluded, \u201cThese preliminary results indicate that a published treatment guideline can be used to develop an assessment tool, and that a focused intervention involving a combination of didactic training and individual provider feedback can improve guideline adherence in the treatment of acutely ill bipolar patients.\u201d For a review of a similar program, see Dennehy et al. \u003Cem\u003EPsychol Med\u003C\/em\u003E 2005;35:1695\u2013706).\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2007 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/7\/2\/34.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzlxyp\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}