Bipolar Disorder Detection, Ascertainment, and Treatment: Primary Care Physician Knowledge, Attitudes, and Awareness

Paul Stang, Ph.D.; Cathy Frank, M.D.; Marianne Ulcickas Yood, D.Sc., M.P.H.; Karen Wells, B.S.; Steven Burch, Ph.D.; and Bruce Muma, M.D., F.A.C.P., F.A.A.P.

Objective: To describe knowledge, attitudes, and awareness of bipolar disorder detection, ascertainment, and treatment among primary care physicians in a managed care setting.

Method: Quota sampling was used to obtain 102 completed surveys assessing knowledge, attitudes, and awareness of bipolar disorder from a pool of 350 primary care physicians in a large, vertically integrated Midwestern health system from June 2004 through August 2004. Descriptive statistics were used to characterize the distribution of the study results at the physician level.

Results: Primary care physicians are experiencing challenges in diagnosing and treating bipolar patients, who can be difficult and time-consuming. In answering questions about major depressive episode and manic episode symptoms, at least 15% of respondents assessed most symptoms incorrectly. In analyzing 3 case studies, 9%, 11%, and 28% of respondents, respectively, answered all of the questions correctly. When asked which drugs are U.S. Food and Drug Administration-approved for the maintenance treatment of adults with bipolar I disorder, no survey respondent replied correctly for all drugs listed. Importantly, our survey also indicates that these physicians are very willing to refer bipolar patients to psychiatrists for evaluation and treatment, which may help to ensure optimal care.

Conclusions: Opportunities for improvement exist in diagnosing and treating patients with bipolar disorder in the primary care setting, perhaps aided by guidelines, education, and a collaborative care model with psychiatry.

(Prim Care Companion J Clin Psychiatry 2006;8:147-152)

Received Sept. 29, 2005; accepted Dec. 21, 2005. From Galt Associates, Blue Bell, Pa. (Drs. Stang and Yood); College of Health Sciences, West Chester University, West Chester, Pa. (Dr. Stang); the Department of Psychiatry, Henry Ford Health System, Detroit, Mich. (Dr. Frank); Epidemiology and Public Health, Yale University School of Medicine, New Haven, Conn. (Dr. Yood); Josephine Ford Cancer Center, Henry Ford Health System, Detroit, Mich. (Dr. Yood and Ms. Wells); GlaxoSmithKline, Research Triangle Park, N.C. (Dr. Burch); and Northern Region, Henry Ford Health System, Detroit, Mich. (Dr. Muma).

This study was funded by GlaxoSmithKline.

Dr. Stang is a consultant to and has served on the speaker or advisory boards for GlaxoSmithKline and other pharmaceutical companies. Dr. Burch is an employee of GlaxoSmithKline. The other authors report no additional financial or other relationships relevant to the subject matter of this article.

Corresponding author and reprints: Paul E. Stang, Ph.D., 620 Sentry Parkway, Suite 100, Blue Bell, PA 19422 (e-mail: pstang@drugsafety.com).