A French network of bipolar expert centres: A model to close the gap between evidence-based medicine and routine practice

Background: Bipolar disorders are a major public health concern. Efforts to provide optimal care by general practitioners and psychiatrists are undermined by the complexity of the disorder and difficulties in applying clinical practice guidelines and new research findings to the spectrum of cases seen in day to day practice. Method: A national network of bipolar expert centres was established. Each centre has established strong links to local health services and provides support to clinicians in delivering personalized care plans derived from systematic case assessments undertaken at the centre. Results: A common set of diagnostic and clinical assessment tools has been adopted at eight centres. Evaluations are undertaken by trained assessors and cross-centre reliability is monitored. A web application, e-bipolar (c) is used to record data in a common computerized medical file. Anonymized data is entered into a shared national database for use in multi-centre audit and research. Conclusions: Instead of offering treatment advice based on clinical practice guidelines recommendations for selected sub-populations of patients (a 'top-down' approach), the French bipolar network offers systematic, comprehensive, longitudinal, and multi-dimensional assessments of cases representative of general bipolar populations. This 'bottom-up' strategy may offer a more efficient and effective way to transfer knowledge and share expertise as the referrer can appreciate the rationale underpinning suggested treatment protocols and more readily apply such principles and approaches to other cases. The network also builds an infrastructure for clinical cohort and comparative-effectiveness research on more representative patient populations. (C) 2010 Elsevier B.V. All rights reserved.