Overview
depression, fatigue, mood disorders, bipolar disorder
In this single-center, unblinded EHR-nested RCT, we compared the effectiveness of EHR-nested reminders for serum lithium monitoring with that of usual care in patients with bipolar disorder or recurrent major depression. EHR-based reminders did not increase the achievement of therapeutic serum lithium concentration between 0.4 and 1.0 mEq/L at the follow-up visit compared to usual care. EHR-based reminders increased the number of serum lithium monitoring but did not decrease the exacerbation of mood disorders during the study period.Monitoring rates of serum lithium level vary greatly among countries and have been reported to be relatively low in the United States and Japan. In the United States, one study showed that only 19% of patients received serum lithium monitoring within 6 months of initiation [Therefore, further efforts to increase the serum lithium monitoring rate are needed when the monitoring rates are low. In the United Kingdom, audit-based quality improvement programs increase the number of patients with 4 serum lithium tests per year from 30% to 48% [In our study, the serum lithium monitoring rate dramatically increased to 94.4%, 3.6 times higher in the reminder group than the usual care group, with simple and inexpensive intervention. In addition, our intervention did not cause “EHR fatigue,” the phenomenon that physicians may stop responding to EHR-alerts when they are exposed to too many alerts [Some studies have implemented and reported EHR-nested alerts. One study showed that EHR-nested alerts reduced unnecessary telemetry without worsening patient outcomes [