Aubry R E, Scott L, Cassidy E
1Graduate Entry Medicine,University College Cork,Cork,Ireland.
2Department of Psychiatry and Neurobehavioural Science,University College Cork,Acute Mental Health Unit,Cork University Hospital,Wilton,Cork.
Ir J Psychol Med. 2017 Jun;34(2):127-140. doi: 10.1017/ipm.2017.2.
The appropriate monitoring of patients on lithium therapy has been the subject of extensive research in the form of clinical audits and surveys culminating in the development of specific guidelines to help clinicians provide optimal care for patients on lithium. The concept of 'shared care' has also gained attention in the literature with various types of shared care interventions being introduced as potential ways of improving communication between primary and secondary care.
This article aims to (1) review the literature evaluating lithium monitoring practices in the United Kingdom and Ireland in the last 25 years and (2) determine whether locally agreed shared care agreements have the potential to improve monitoring quality.
A literature search was conducted using the following databases: PubMed, Scopus, Web of Science, Academic Search Premier, CINAHL and PsychInfo. A total of 12 studies were selected for review including 11 audits/prospective chart reviews and one qualitative study using semi-structured interviews.
Overall, the quality of lithium monitoring seems to be improving throughout the years. However, none of the studies reviewed revealed complete adherence to monitoring guidelines. This may be due to a lack of effective communication between primary and secondary care. Several shared care interventions have been described in the literature but there is a paucity of studies concerned with the effects of local shared care arrangements designed for the specific purpose of lithium monitoring. Nonetheless, the extant data suggests that such agreements may help improve monitoring standards by allowing the responsibilities for managing the prescribing and monitoring of lithium to be more clearly defined and shared between primary and secondary care.
对接受锂盐治疗的患者进行适当监测一直是广泛研究的主题，这些研究以临床审计和调查的形式展开，最终形成了具体指南，以帮助临床医生为接受锂盐治疗的患者提供最佳护理。“共享护理”的概念在文献中也受到了关注，各种类型的共享护理干预措施被引入，作为改善初级和二级护理之间沟通的潜在方式。
本文旨在（1）回顾过去25年中评估英国和爱尔兰锂盐监测实践的文献，以及（2）确定当地商定的共享护理协议是否有可能提高监测质量。
使用以下数据库进行文献检索：PubMed、Scopus、Web of Science、Academic Search Premier、CINAHL和PsychInfo。总共选择了12项研究进行综述，包括11项审计/前瞻性病历审查和1项使用半结构化访谈的定性研究。
总体而言，多年来锂盐监测的质量似乎在不断提高。然而，所审查的研究均未显示完全遵守监测指南。这可能是由于初级和二级护理之间缺乏有效的沟通。文献中描述了几种共享护理干预措施，但针对锂盐监测这一特定目的的当地共享护理安排的效果的研究却很少。尽管如此，现有数据表明，此类协议可能有助于提高监测标准，因为它能让锂盐处方管理和监测的责任在初级和二级护理之间得到更明确的界定和分担。
