A survey of Saskatchewan family physicians, psychiatrists and pharmacists assessing barriers in lithium use

Abstract

Background: Lithium is a popular mood stabilizer. Anecdotally, it is an underutilized medication in primary care. We conducted a survey of family physicians (FPs), pharmacists and psychiatrists in Saskatchewan to examine attitudes towards and knowledge of lithium use in bipolar disorder (BD). Methods: FPs, psychiatrists and pharmacists within Saskatchewan were contacted via email addresses provided by the Saskatchewan Medical Association, Pharmacy Association of Saskatchewan and Canadian Society of Hospital Pharmacists – Saskatchewan Branch and a link to an online survey provided. Results: Responses were obtained from 209 participants – 30 psychiatrists, 103 FPs and 76 pharmacists. Lithium was considered a specialist medication by 63.11% of FPs and 70% of psychiatrists. Lithium was the first choice for maintenance treatment of BD by 31.03% of psychiatrists and 13.68% of FPs, atypical antipsychotics being preferred by both (37.93 and 44.21%, respectively). 72% of the FPs were hesitant to initiate lithium and yet 73.79% felt comfortable monitoring patients already on it. FPs hesitancy could be related to a lack of knowledge in initiating or adjusting lithium doses (53.9%), how the medication works (28.7%), need for blood tests (34.95%), concern about suicidal ideas (11.5%) and the feeling of needing more education on prescribing lithium (79%). 33.69% of FPs were unsure about reference lithium levels or did not use it for monitoring. Limitations and conclusions: Limited by small sample size, we observed significant apprehensions about prescribing lithium in this study, more should done in encouraging its use in BD management.

Keywords

• Lithium
• Stigma
• Family physician
• Psychiatrists