Does the Ranking Matter? A Retrospective Cohort Study Investigating the Impact of the 2018 CANMAT and ISBD Guidelines for the Management of Patients with Bipolar Disorder Treatment Recommendations for Acute Mania on Rehospitalization Rates.

IF 3.3 3区 医学 Q2 PSYCHIATRY
Fabiano A Gomes, Henrique Dumay, Julia Fagen, Natalie Palma, Roumen Milev, Elisa Brietzke
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引用次数: 0

Abstract

Objective: There is limited data about the impact of mood disorders treatment guidelines on clinical outcomes. The objective of this study was to investigate the impact of prescribers' adherence to the 2018 Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) treatment guidelines recommendations on the readmission rates of patients hospitalized for mania.

Method: A retrospective cohort of all individuals admitted due to acute mania to Kingston General Hospital, Kingston, ON, from January 2018 to July 2021 was included in this study. Patient variables and data regarding index admission and subsequent hospitalizations were extracted from medical records up to December 31, 2021. Treatment regimens were classified as first-line, second-line, noncompliant, or no treatment. We explored the associations between treatment regimens and the risk of readmissions using univariate, multivariate, and survival analysis.

Results: We identified 211 hospitalizations related to 165 patients. The mean time-to-readmission was 211.8 days (standard deviation [SD]  =  247.1); the 30-day rehospitalization rate was 13.7%, and any rehospitalization rate was 40.3%. Compared to no treatment, only first-line treatments were associated with a statistically significant decreased risk of 30-day readmission (odds ratio [OR] = 0.209; 95% CI, 0.058 to 0.670). The risk of any readmission was reduced by first-line (OR = 0.387; 95% CI, 0.173 to 0.848) and noncompliant regimens (OR = 0.414; 95% CI, 0.174 to 0.982) compared to no treatment. On survival analysis, no treatment group was associated with shorter time-to-readmission (log-rank test, p  =  0.014) and increased risk of readmission (hazard ratio = 2.27; 95% CI, 1.30 to 3.96) when compared to first-line medications.

Conclusions: Treatment with first-line medications was associated with lower 30-day rehospitalization rates and longer time-to-readmission. Physicians' adherence to treatments with higher-ranked evidence for efficacy, safety, and tolerability may improve bipolar disorder outcomes.

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排名重要吗?一项回顾性队列研究调查了2018年CANMAT和ISBD双相情感障碍患者管理指南对急性躁狂症治疗建议对再住院率的影响。
目的:关于情绪障碍治疗指南对临床结果影响的数据有限。本研究的目的是调查处方者遵守2018年加拿大情绪和焦虑治疗网络(CANMAT)和国际双相情感障碍学会(ISBD)治疗指南建议对躁狂症住院患者再入院率的影响。方法:本研究纳入了2018年1月至2021年7月在安大略省金斯顿的金斯顿总医院因急性躁狂入院的所有个体。从截至2021年12月31日的医疗记录中提取有关指数入院和随后住院的患者变量和数据。治疗方案分为一线、二线、不依从性和无治疗。我们通过单变量、多变量和生存分析探讨了治疗方案与再入院风险之间的关系。结果:我们确定了211例与165例患者相关的住院情况。平均再入院时间为211.8天(标准差[SD] = 247.1);30天再住院率为13.7%,任意再住院率为40.3%。与未治疗相比,仅一线治疗与30天再入院风险降低有统计学意义(优势比[OR] = 0.209;95% CI, 0.058 ~ 0.670)。一线患者再入院的风险降低(OR = 0.387;95% CI, 0.173 - 0.848)和非依从性方案(OR = 0.414;95% CI, 0.174 ~ 0.982)。在生存分析中,没有治疗组与再入院时间较短(log-rank检验,p = 0.014)和再入院风险增加相关(风险比= 2.27;95% CI, 1.30至3.96),与一线药物相比。结论:一线药物治疗与较低的30天再住院率和较长的再入院时间相关。医生对疗效、安全性和耐受性证据较高的治疗方法的坚持可能会改善双相情感障碍的预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
7.00
自引率
2.50%
发文量
69
审稿时长
6-12 weeks
期刊介绍: Established in 1956, The Canadian Journal of Psychiatry (The CJP) has been keeping psychiatrists up-to-date on the latest research for nearly 60 years. The CJP provides a forum for psychiatry and mental health professionals to share their findings with researchers and clinicians. The CJP includes peer-reviewed scientific articles analyzing ongoing developments in Canadian and international psychiatry.
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