Bipolar Disorder in Primary Care: Integrated Care Experiences

Primary care clinics are increasingly implementing collaborative care models to care for patients with psychiatric illnesses in primary care. The evidence base for the effectiveness of collaborative care has largely been derived from the care of patients with depression or anxiety disorders, although psychiatrists working in primary care may encounter patients with illnesses other than depression or anxiety disorder, notably bipolar disorder. Patients with bipolar disorder report having received treatment in primary care in equal proportions as those in specialty care settings over the past 12 months, although quality of care is lower in primary care than in specialty care settings. For patients already presenting to primary care, collaborative care is one population-based care model that may increase the proportion of individuals with bipolar disorder who are exposed to high-quality psychiatric care, such as appropriate medication treatment and laboratory monitoring. The primary care setting may even present unexpected strengths in caring for patients with bipolar disorder. Solutions to barriers to expanding the scope of collaborative care to include patients with bipolar disorder may apply to the care of patients with other complex disorders in the primary care setting.