An investigation of the effect of different methods of patient management on the outcome of lithium therapy.

Patients prescribed long-term lithium therapy require regular monitoring which can be carried out in a variety of management settings, the most common of which are by specialised lithium clinics (LC), general psychiatric out-patient clinics (OP) and general practice (GP). Whilst audits have been carried out comparing standards of monitoring in these settings, no thorough investigation has been undertaken previously to compare all aspects of significance in lithium therapy. A study was designed to compare standards of monitoring, effectiveness, compliance and attitude to lithium therapy, incidence, frequency and severity of side effects and incidence of toxicity between the different management settings. Patients were recruited (N=281) from Tayside and Aberdeen, following the approval of respective Medical Ethics Committees. Data was collected by patient interview, clinician questionnaire and from patients’ medical and/or psychiatric case notes. The data acquired was then used to generate and test overall indices for outcome, combining all aspects of lithium therapy, using and testing novel methodology for index generation. Lithium clinics showed closest adherence to guidelines for frequency of monitoring plasma lithium levels, thyroid and renal function (% within 2 or 3 of 3: LC=70%, OP=15%, GP=12%, p< 0.00001, x2) and reduced incidence of toxicity (LC=1.7%, OP=11.1%, GP=28.8%, p< 0.01, x2) and general practice performed worst. Response to lithium was more likely to be categorised as ‘Total’ or ‘Good’ in lithium clinic patients (LC=66.4%, OP=45.2%, GP=49.4%, p< 0.05, x2) Less conclusive evidence suggested general psychiatric out-patient clinics were better than general practice for effectiveness of therapy and general practice patients had poorer compliance. Overall indices for outcome were tested by combining continuous and categorical data. The use of categorical data was more useful producing a final index which was a continuous variable (mean = 6.6 , s.d. = 3.37, range = -2 to 14) with a normal distribution (p<0.01, x2, v=8). This index confirmed the results found above (LC>OP>GP, p<0.001, One Way ANOVA). A sample size of 126 was required to detect any clinically significant change using the final index.

Grantor dc:publisher.institution

Robert Gordon University

Year dc:date.issued

1998

Author dc:creator

• Nicol, Marie H.

Advisor dc:contributor.advisor

• K.E. Kendle and J. Krska

• Lithium therapy monitoring
• Lithium clinics
• Patient compliance
• Treatment effectiveness
• Outcome indices

Language dc:language

en

Identifier

oai:rgu-repository.worktribe.com:2807505
https://doi.org/10.48526/rgu-wt-2807505

OAI identifier oai:identifier

oai:rgu-repository.worktribe.com:2807505