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Bipolar Disorder Center for Pennsylvanians: Implementing an Effectiveness Trial to Improve Treatment for At-Risk Patients

Dr. Kupfer, Dr. Axelson, Dr. Birmaher, Dr. Brown, Mr. Curet, Dr. Frank, Dr. Friedman, Dr. Grochocinski, Ms. Houck, Dr. Reynolds, Ms. Stofko, Dr. Swartz, and Dr. Whyte are affiliated with the Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara St., Pittsburgh, PA 15213 (e-mail: kupferdj{at}upmc.edu). Dr. Fagiolini is with the Department of Neuropsychiatry, University of Siena School of Medicine, Siena, Italy. Dr. Kilbourne is with the Department of Psychiatry, Serious Mental Illness Treatment Research and Evaluation Center, University of Michigan, Ann Arbor. Dr. Mulsant and Dr. Pollock are with the Department of Psychiatry, University of Toronto, Toronto, Ontario. Dr. Thase is with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Dr. Turkin is with the Department of Psychiatry, DuBois Regional Medical Center, Behavioral Outpatient Clinic, DuBois, Pennsylvania.

OBJECTIVE: Adolescents, elderly persons, African Americans, and rural residents with bipolar disorder are less likely than their middle-aged, white, urban counterparts to be diagnosed, receive adequate treatment, remain in treatment once identified, and have positive outcomes. The Bipolar Disorder Center for Pennsylvanians (BDCP) study was designed to address these disparities. This report highlights the methods used to recruit, screen, and enroll a cohort of difficult-to-recruit individuals with bipolar disorder. METHODS: Study sites included three specialty clinics for bipolar disorder in a university setting and a rural behavioral health clinic. Study operations were standardized, and all study personnel were trained in study procedures. Several strategies were used for recruitment. RESULTS: It was possible to introduce the identical assessment and screening protocol in settings regardless of whether they had a history of implementing research protocols. This protocol was also able to be used across the age spectrum, in urban and rural areas, and in a racially diverse cohort of participants. Across the four sites 515 individuals with bipolar disorder were enrolled as a result of these methods (69 African Americans and 446 non-African Americans). Although clinical characteristics at study entry did not differ appreciably between African Americans and non-African Americans, the pathways into treatment differed significantly. CONCLUSIONS: Rigorous recruitment and assessment procedures can be successfully introduced in different settings and with different patient cohorts, thus facilitating access to high-quality treatment for individuals who frequently do not receive appropriate care for bipolar disorder.

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