Collaborative care psychiatrists’ views on treating bipolar disorder in primary care: a qualitative study

Abstract

Objective To understand collaborative care psychiatric consultants’ views and practices on making the diagnosis of and recommending treatment for bipolar disorder in primary care using collaborative care. Method We conducted a focus group at the University of Washington in December 2013 with nine psychiatric consultants working in primary care-based collaborative care in Washington State. A grounded theory approach with open coding and the constant comparative method revealed categories where emergent themes were saturated and validated through member checking, and a conceptual model was developed. Results Three major themes emerged from the data including the importance of working as a collaborative care team, the strengths of collaborative care for treating bipolar disorder, and the need for psychiatric consultants to adapt specialty psychiatric clinical skills to the primary care setting. Other discussion topics included gathering clinical data from multiple sources over time, balancing risks and benefits of treating patients indirectly, tracking patient care outcomes with a registry, and effective care. Conclusion Experienced psychiatric consultants working in collaborative care teams provided their perceptions regarding treating patients with bipolar illness including identifying ways to adapt specialty psychiatric skills, developing techniques for providing team-based care, and perceiving the care delivered through collaborative care as high quality.

Collaborative care for a patient with bipolar disorder in primary care: a case example

“…The consulting psychiatrists who attended the conference consulted to primary care clinics involved in MHIP, and included many of the consulting psychiatrists from a study examining the views of consulting psychiatrists on treating patients with bipolar disorder in primary care (12). A major challenge for psychiatrists in collaborative care is balancing the uncertainty of indirectly caring for a patient, with the need to decisively assist primary care teams with managing a patient population with complex medical and psychiatric comorbidity.…”

Bipolar Disorder in Primary Care: Integrated Care Experiences

“…This information is then reported to the collaborative care psychiatrist weekly during consultation, giving many opportunities to revise and update diagnostic impressions through an iterative process (12, 13). Having many opportunities to revise a diagnostic impression, and knowing that the diagnosis can be revised over time, can increase the consulting psychiatrist’s comfort with diagnosing bipolar disorder in primary care (14). …”

“…The first perspective includes a patient case and clinician views derived from a case summary of a previously published report and study of collaborative care psychiatrists (14, 26). The second is from the perspective of a larger population of primary care patients with bipolar disorder.…”

“…Interviews with consulting psychiatrists who have cared for patients with bipolar disorder in primary care revealed several themes, including the importance of working as a collaborative care team, strengths of collaborative care in evaluating and treating patients with bipolar disorder, and the need for consulting psychiatrists to adapt specialty skills to primary care (14). This case example illustrates these themes by describing how collaborative care team members work together to recognize bipolar disorder and provide high-quality care to patients in primary care, including monitoring response to treatment and adjusting treatments when needed —which require adapting specialty skills to primary care.…”

Financing for Collaborative Care—a Narrative Review

“…To date, the efficacy and effectiveness of CoCM have been shown in more than eighty RCTs 1,2 . Additionally, using its core principles, others have extended CoCM to the treatment of individuals: (1) in a variety of treatment settings (e.g., inpatient treatment 3 and specialty medical care 4 ), (2) with a number of mental health diagnoses (e.g., anxiety 1 , bipolar disorder 5 and post-traumatic stress disorder 6–8 ) and (3) of different age ranges (e.g., adolescents 9 ). Despite its robust evidence base and extensive use, payment for this care model has remained a challenging task for states, municipalities, payers and healthcare systems.…”