Project Summary
Background: Second-generation antipsychotic (SGAs) medications effectively manage symptoms of bipolar spectrum disorders (BSD) in youth, but SGA-related weight gain and metabolic side effects carry substantial risks. Data suggest that these youth are willing to start interventions to minimize weight gain at SGA initiation. However, clinicians and caregivers are unlikely to intervene until youth have voiced concern about weight gain. Clinicians and other stakeholders also report a lack of knowledge regarding available solutions to SGA-related side effects. MOBILITY, a PCORI-funded comparative clinical effectiveness research (CER) study, compares metformin plus a healthy lifestyle (LIFE) to LIFE alone among youth with BSD. Key outcomes include weight gain, metabolic alterations and mood stability. Other PCORI-funded studies compare SGAs to other mood stabilizing medications, report effective weight-mitigation strategies and provide patient-centered feedback on the use of adult versus child guidelines for lipid testing and treatment.
Proposed Solution to the Problem: To fill the gap in awareness of effective weight management strategies for youth with BSD, project leads from the University of Cincinnati and Depression and Bipolar Support Alliance will build capacity to disseminate this evidence by convening a steering committee and focus groups of stakeholders who will meet online to determine what data from PCORI-funded research studies relevant to youth with BSD will best support decision-making, and how this information should be disseminated to patients, caregivers and other stakeholders, so that a fast path from evidence to action is created by transferring knowledge about evidence-based management of SGA-related side effects to representative stakeholders.
Objectives: The primary aims of this project are to build capacity to:
- Understand what aspects of MOBILITY and other related-PCOR/CER study findings are most salient to stakeholders.
- Effectively and rapidly disseminate these findings so that youth with BSD experience improved outcomes.
Activities: The project team will reach their objectives through bi-weekly Steering Committee meetings to identify key priorities and themes important to stakeholders, review qualitative and quantitative findings from focus groups, design targeted messaging and dissemination pathways for each stakeholder group and evaluate the progress of efforts.
Projected Outcomes and Outputs:
Short-term outcomes during the project period include enhanced capacity for targeted dissemination of PCOR/CER findings to stakeholder organizations, targeted messaging for each stakeholder and end user group and tailored communication strategies.
Medium-term outcomes (0-2 years post-project period) include increased reach and widespread adoption of SGA side effect mitigation strategies.
Long-term outcomes (3+ years post-project period) include improved physical and mental health of youth with BSD.
Deliverables include a qualitative analysis of patient-, caregiver- and clinician-reported key barriers and facilitators to dissemination; stakeholder-informed evidence-based recommendations to address BSD treatment/side effects; quantitative analyses of stakeholder engagement and increased knowledge and acceptability; and a resource detailing learnings on most acceptable dissemination strategies.
Patient and Stakeholder Engagement Plan: The project team will engage youth living with BSD; their caregivers and prescribers; and representatives of health systems, community mental health agencies, professional organizations and payers. They will meet regularly as part of the Steering Committee and focus groups to identify relevant PCORI-funded evidence and provide feedback on preferred mechanisms to reach end users.
Project Collaborators:
- University of Cincinnati/Cincinnati Children’s Hospital Medical Center
- Depression and Bipolar Support Alliance
- American Academy of Child and Adolescent Psychiatry
- CareSource