Monitoring of patients treated with lithium for bipolar disorder: an international survey

Abstract

BackgroundAdequate monitoring of patients using lithium is needed for optimal dosing and for early identification of patients with (potential) ADEs. The objective was to internationally assess how health care professionals monitor patients treated with lithium for bipolar disorder.MethodsUsing networks of various professional organizations, an anonymous online survey was conducted among health care professionals prescribing lithium. Target lithium serum levels and frequency of monitoring was assessed together with monitoring of physical and laboratory parameters. Reasons to and not to monitor and use of guidelines and institutional protocols, and local monitoring systems were investigated.ResultsThe survey was completed by 117 health care professionals incorporating responses from twenty-four countries. All prescribers reported to monitor lithium serum levels on a regular basis, with varying target ranges. Almost all (> 97%) monitored thyroid and renal function before start and during maintenance treatment. Reported monitoring of other laboratory and physical parameters was variable. The majority of respondents (74%) used guidelines or institutional protocols for monitoring. In general, the prescriber was responsible for monitoring, had to request every monitoring parameter separately and only a minority of patients was automatically invited.ConclusionsLithium serum levels, renal and thyroid function were monitored by (almost) all physicians. However, there was considerable variation in other monitoring parameters. Our results help to understand why prescribers of lithium monitor patients and what their main reasons are not to monitor patients using lithium.Electronic supplementary materialThe online version of this article (10.1186/s40345-018-0120-1) contains supplementary material, which is available to authorized users.

Evaluation of clarity of presentation and applicability of monitoring instructions for patients using lithium in clinical practice guidelines for treatment of bipolar disorder

“…“lithium”, “bipolar disorder” and “guideline” were used as search terms (Appendix 1). In addition to this literature search, prescribers of lithium participating in an online survey from our research group were requested to report guidelines that they use for monitoring of patients using lithium …”

“…In addition to this literature search, prescribers of lithium participating in an online survey from our research group were requested to report guidelines that they use for monitoring of patients using lithium. 9 CPGs had to meet four criteria to be selected for assessment in the present study. First, a statement was required that the publication was indeed a guideline.…”

“…In addition to the quality of the monitoring instructions in CPGs, it is important that monitoring instructions are easily identifiable and applicable for health care professionals. In a recent study from our research group, 74% of lithium prescribers stated that their monitoring policy was based on a guideline or institutional protocol …”

“…In a recent study from our research group, 74% of lithium prescribers stated that their monitoring policy was based on a guideline or institutional protocol. 9 To be applicable for health care professionals, it is important that guidelines address which and how clinical or biomarker parameters need to be monitored. Information is needed on when to start monitoring, when to stop monitoring, how frequently to monitor, what critical values are and how to respond to these values.…”

Compliance with the guidelines for laboratory monitoring of patients treated with lithium: A retrospective follow‐up study among ambulatory patients in the Netherlands

“…In a previous survey by our group, prescribers of lithium reported to monitor at least one parameter within the first 6 months and during maintenance treatment in patients using lithium . Especially lithium serum levels, creatinine, and TSH were reported to be monitored by almost all prescribers of lithium . Although prescribers report to monitor patients using lithium, it is unknown whether in clinical practice patients are actually monitored for lithium serum levels, creatinine, and TSH.…”