Nederlof M, Heerdink E R, Egberts A C G, Wilting I, Stoker L J, Hoekstra R, Kupka R W
Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3508 TB, Utrecht, The Netherlands.
Brocacef Ziekenhuisfarmacie, 3600 AB, Maarssen, The Netherlands.
Int J Bipolar Disord. 2018 Apr 14;6(1):12. doi: 10.1186/s40345-018-0120-1.
Adequate monitoring of patients using lithium is needed for optimal dosing and for early identification of patients with (potential) ADEs. The objective was to internationally assess how health care professionals monitor patients treated with lithium for bipolar disorder.
Using networks of various professional organizations, an anonymous online survey was conducted among health care professionals prescribing lithium. Target lithium serum levels and frequency of monitoring was assessed together with monitoring of physical and laboratory parameters. Reasons to and not to monitor and use of guidelines and institutional protocols, and local monitoring systems were investigated.
The survey was completed by 117 health care professionals incorporating responses from twenty-four countries. All prescribers reported to monitor lithium serum levels on a regular basis, with varying target ranges. Almost all (> 97%) monitored thyroid and renal function before start and during maintenance treatment. Reported monitoring of other laboratory and physical parameters was variable. The majority of respondents (74%) used guidelines or institutional protocols for monitoring. In general, the prescriber was responsible for monitoring, had to request every monitoring parameter separately and only a minority of patients was automatically invited.
Lithium serum levels, renal and thyroid function were monitored by (almost) all physicians. However, there was considerable variation in other monitoring parameters. Our results help to understand why prescribers of lithium monitor patients and what their main reasons are not to monitor patients using lithium.
为实现最佳给药并早期识别（潜在）药物不良反应患者，需要对使用锂盐的患者进行充分监测。目的是在国际范围内评估医疗保健专业人员如何监测双相情感障碍患者使用锂盐的情况。
通过各专业组织网络，对开具锂盐处方的医疗保健专业人员进行了一项匿名在线调查。评估了锂盐血清靶标水平和监测频率，以及身体和实验室参数的监测情况。调查了监测或不监测的原因、指南和机构规程的使用情况以及当地监测系统。
117名医疗保健专业人员完成了调查，其回复来自24个国家。所有开处方者均报告定期监测锂盐血清水平，靶标范围各不相同。几乎所有（>97%）在开始治疗和维持治疗期间都监测甲状腺和肾功能。报告的其他实验室和身体参数监测情况各不相同。大多数受访者（74%）使用指南或机构规程进行监测。一般来说，开处方者负责监测，必须分别要求每项监测参数，只有少数患者会被自动邀请。
（几乎）所有医生都监测锂盐血清水平、肾功能和甲状腺功能。然而，其他监测参数存在很大差异。我们的结果有助于理解为什么锂盐开处方者会监测患者，以及他们不监测锂盐治疗患者的主要原因是什么。
