Clinical Outcomes of a Pharmaceutical Care Service in Lithium Clinic adjunct to Standard Care Compared with Standard Care Alone in Patients with Bipolar Disorder: 10 years Naturalistic Retrospective Cohort Study

Objective: To compare the long-term clinical outcomes of bipolar patients following lithium maintenance therapy between patients who received standard care plus pharmaceutical care service (lithium clinic group) and patients who received standard care alone (usual care group). Materials and Methods: This study was a single-center retrospective cohort study. Clinical outcomes were compared between the lithium clinic (n = 120) and usual care groups (n = 240) between January 2006 and December 2015. Results and discussion: Average study observation time was 6.11 + 3.14 years. Hospitalization rate due to any recurrence in lithium clinic group (0.0545 + 0.170 times per year) was significantly less than usual care group (0.1815 + 0.428 times per year). Also, hospitalization rate from manic recurrence and emergency room visit rate in lithium clinic group (0.0449 + 0.147 and 0.0286 + 0.133 times per year, respectively) was significantly lower than usual care group (0.1582 + 0.392 and 0.1507 + 0.474 times per year, respectively). Furthermore, lithium clinic group had risk of any recurrence (RR= 0.744, P=0.02), manic recurrence (RR= 0.613, P=0.001) and manic admission (RR= 0.439, P=0.0001) significantly less than usual care group. Median time to manic recurrence was 4.44 (IQR 3.59-5.29) years for lithium clinic group, but 3.54 (IQR 3.08-3.99) years for usual care group. Median time to manic admission was 5.36 (IQR 4.81-5.92) and 3.98 (IQR 3.21-4.76) years for lithium clinic and usual care groups, respectively. Moreover, median time to emergency room visit was 5.36 (IQR 4.93-5.80) years in lithium clinic and 4.09 (IQR 3.46 – 4.72) years in usual care groups. Conclusion: Lithium clinic group had better long-term clinical outcomes than usual care group. Therefore, pharmaceutical care in bipolar disorder patients is beneficial and should be implemented for other psychiatric hospitals.