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Am J Psychiatry 1996; 153:993-1000
Copyright © 1996 by American Psychiatric Association
Lithium use and discontinuation in a health maintenance organization
RE Johnson and BH McFarland
Center for Health Research, Kaiser Permanente Northwest Region, Portland, OR 97227-1098, USA.
OBJECTIVE: For decades, lithium has been prescribed to treat bipolar
disorder. Its efficacy has been documented by clinical trials and by data
from specialized clinics. An issue of considerable interest is the use of
lithium in managed care systems. This project examined the use of lithium
and its continuity of use by enrollees of a health maintenance organization
(HMO). METHOD: In a 6-year longitudinal cohort study, 1,594 lithium users
aged 15 years and older who were enrolled in an HMO were followed from
1986-1991. Data were obtained from automated databases and from medical
record review of a random 5% subsample of the group (N = 74). RESULTS:
Bipolar disorder was the most frequent morbidity treated. Eighty-four
percent (N = 62 or 74) received services from a psychiatrist. Annual
prevalence of lithium use increased over the 6-year period from 1.4 to 2.3
persons per thousand HMO members. Duration of use varied widely with some
long-term but many short-term users. Discontinuation of treatment was
associated with evaluated rates of psychiatric hospitalization and use of
psychiatric emergency services. Lithium users were much more likely to
receive a variety of other psychotropic drugs than nonusers of the same sex
and age. CONCLUSIONS: Lithium use in this population was more often
sporadic than continuous. Discontinuation of lithium was associated with
psychiatric hospitalization. If lithium is to be a cost-effective treatment
for bipolar disorder, managed care systems will need to improve adherence
to drug treatment regimens.
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Sporadic Lithium Use Associated with High Morbidity and Costs
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1996(1001):
15 - 15.
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