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Bipolar disorder: assessment and management [CG185]

Measuring the use of this guidance

Recommendation: 1.2.12

Ensure that the physical health check for people with bipolar disorder, performed at least annually, includes: weight or BMI, diet, nutritional status and level of physical activity cardiovascular status, including pulse and blood pressure metabolic status, including fasting blood glucose, glycosylated haemoglobin (HbA1c) and blood lipid profile liver function renal and thyroid function, and calcium levels, for people taking long‑term lithium.

What was measured: Proportion of patients with schizophrenia, bipolar affective disorder and other psychoses who have a record of blood pressure in the preceding 12 months.
Data collection end: March 2015
81.5%
Area covered: England
Source: Health and Social Care Information Centre. Quality Outcomes Framework.

What was measured: MH009: The percentage of patients on lithium therapy with a record of serum creatinine and TSH in the preceding 9 months.
Data collection end: March 2016
93.4%
Data collection end: March 2017
94.5%
Area covered: National
Source: Health and Social Care Information Centre. Quality and Outcomes Framework.

What was measured: MH003: The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a record of blood pressure in the preceding 12 months.
Data collection end: March 2016
81%
Data collection end: March 2017
82.2%
Area covered: National
Source: Health and Social Care Information Centre. Quality and Outcomes Framework.


Recommendation: 1.3.4

If bipolar disorder is diagnosed, develop a care plan in collaboration with the person with bipolar disorder based on the assessment carried out in recommendation 1.3.2 as soon as possible after assessment and, depending on their needs, using the care programme approach. Give the person and their GP a copy of the plan, and encourage the person to share it with their carers.

What was measured: Proportion of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive care plan documented in the record, in the preceding 12 months, agreed between individuals, their family and/or carers as appropriate.
Data collection end: March 2015
77.2%
Area covered: England
Source: Health and Social Care Information Centre. Quality Outcomes Framework.

What was measured: MH002: The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive care plan documented in the record, in the preceding 12 months, agreed between individuals, their family and/or carers as appropriate.
Data collection end: March 2016
77.5%
Data collection end: March 2017
79%
Area covered: National
Source: Health and Social Care Information Centre. Quality and Outcomes Framework.


Recommendation: 1.10.15

Measure plasma lithium levels 1 week after starting lithium and 1 week after every dose change, and weekly until the levels are stable. Aim to maintain plasma lithium level between 0.6 and 0.8 mmol per litre in people being prescribed lithium for the first time.

What was measured: Proportion of patients on lithium therapy with a record of lithium levels in the therapeutic range in the preceding 4 months.
Data collection end: March 2015
82.6%
Area covered: England
Source: Health and Social Care Information Centre. Quality Outcomes Framework.

What was measured: MH010: The percentage of patients on lithium therapy with a record of lithium levels in the therapeutic range in the preceding 4 months.
Data collection end: March 2016
81.3%
Data collection end: March 2017
83%
Area covered: National
Source: Health and Social Care Information Centre. Quality and Outcomes Framework.


Recommendation: 1.10.20

After the first year, measure plasma lithium levels every 6 months, or every 3 months for people in any of the following groups: - older people - people taking drugs that interact with lithium - people who are at risk of impaired renal or thyroid function, raised calcium levels or other complications - people who have poor symptom control - people with poor adherence - people whose last plasma lithium level was 0.8 mmol per litre or higher.

What was measured: Proportion of patients whose lithium level was tested at least once every 6 months.
Data collection end: January 2016
76.2%
Number that met the criteria: 93 / 123
Area covered: Local
Source: Nikolova Viktoriya L, Pattanaseri Keerati, Hidalgo-Mazzei Diego, Taylor David, and Young Allan H (2018) Is lithium monitoring NICE? Lithium monitoring in a UK secondary care setting. Journal of psychopharmacology (Oxford, and England) 32(4), 408-415

What was measured: Proportion of patients aged over 65 whose lithium level was tested at least once every 3 months.
Data collection end: January 2016
50%
Number that met the criteria: 5 / 10
Area covered: Local
Source: Nikolova Viktoriya L, Pattanaseri Keerati, Hidalgo-Mazzei Diego, Taylor David, and Young Allan H (2018) Is lithium monitoring NICE? Lithium monitoring in a UK secondary care setting. Journal of psychopharmacology (Oxford, and England) 32(4), 408-415

What was measured: Proportion of patients on any medication interacting with lithium whose lithium level was tested at least once every 3 months.
Data collection end: January 2016
56.8%
Number that met the criteria: 42 / 74
Area covered: Local
Source: Nikolova Viktoriya L, Pattanaseri Keerati, Hidalgo-Mazzei Diego, Taylor David, and Young Allan H (2018) Is lithium monitoring NICE? Lithium monitoring in a UK secondary care setting. Journal of psychopharmacology (Oxford, and England) 32(4), 408-415

What was measured: Proportion of patients with chronic comorbid hypertension, diabetes and/or any thyroid disorder whose lithium level was tested at least once every 3 months.
Data collection end: January 2016
47.8%
Number that met the criteria: 11 / 23
Area covered: Local
Source: Nikolova Viktoriya L, Pattanaseri Keerati, Hidalgo-Mazzei Diego, Taylor David, and Young Allan H (2018) Is lithium monitoring NICE? Lithium monitoring in a UK secondary care setting. Journal of psychopharmacology (Oxford, and England) 32(4), 408-415


Recommendation: 1.10.21

Measure the person's weight or BMI and arrange tests for urea and electrolytes including calcium, estimated glomerular filtration rate (eGFR) and thyroid function every 6 months, and more often if there is evidence of impaired renal or thyroid function, raised calcium levels or an increase in mood symptoms that might be related to impaired thyroid function.

What was measured: Proportion of patients whose renal function was tested at least once every 6 months.
72.7%
Number that met the criteria: 88 / 123
Area covered: Local
Source: Nikolova Viktoriya L, Pattanaseri Keerati, Hidalgo-Mazzei Diego, Taylor David, and Young Allan H (2018) Is lithium monitoring NICE? Lithium monitoring in a UK secondary care setting. Journal of psychopharmacology (Oxford, and England) 32(4), 408-415

What was measured: Proportion of patients whose thyroid function was tested at least once every 6 months.
Data collection end: January 2016
60.2%
Number that met the criteria: 74 / 123
Area covered: Local
Source: Nikolova Viktoriya L, Pattanaseri Keerati, Hidalgo-Mazzei Diego, Taylor David, and Young Allan H (2018) Is lithium monitoring NICE? Lithium monitoring in a UK secondary care setting. Journal of psychopharmacology (Oxford, and England) 32(4), 408-415



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