Consider Bringing the RMS Into Your Primary Care Practice - It’s Quick and Flexible
There are two ways to administer the RMS: automated case finding, which screens patients routinely, or provider-initiated case finding, which you trigger yourself when you suspect bipolar disorder during a visit.
If your clinic uses Ocean, you can set up either approach—or both. If you’re not on Ocean, you can still use the RMS by using the printable PDF or by manually adding the RMS to your existing EMR.
Automated case finding
Option 1: Using Ocean
If your clinic uses Ocean, you can set up an automated case finding workflow.
Using Ocean’s online booking solution, patients can schedule their own mental health appointments. When they do, you can have them automatically receive the PHQ-9 (Patient Health Questionnaire-9) form, a widely used form for screening depression symptoms in primary care. Those who receive a score of 10 or higher (positive screen for depression) will automatically be given the RMS to complete. The responses from both screeners are securely synced into their chart in the EMR and ready for patient-provider discussion.
Note: If a patient's PHQ-9 responses indicate risk of self-harm, Ocean automatically presents a suicide risk questionnaire in place of the RMS.
The advantage is that you don't have to remember to send the RMS. Case finding happens for every patient who indicates depressive symptoms. Since bipolar disorder is frequently mistaken for major depressive disorder, this catches the cases that might otherwise be missed and helps guide the right treatment path.
We know your time is valuable, you can claim QI credits for setting up this workflow. Click here for more info.
Estimated installation time: <30 mins
Option 2: Other EMR integrations
You can manually set up a similar workflow in other platforms. Detailed instructions are coming soon for TELUS Health and OSCAR.
Physician-initiated case finding
If your clinic is not on Ocean, or you prefer to use the RMS selectively, you can administer it yourself, either as a printed PDF or using the Ocean eForm, when you suspect there is a risk of bipolar, for the patient to complete during or between appointments.
When to use the RMS
Consider the RMS when bipolar disorder is suspected. The Canadian Network for Mood and Anxiety Treatments (CANMAT) / International Society for Bipolar Disorders (ISBD) guidelines for the management of patients with bipolar disorder note the following features that may increase suspicion of bipolar disorder.
Symptomatology and mental state signs
• Hypersomnia and/or increased daytime napping
• Hyperphagia and/or increased weight
• Other “atypical” depressive symptoms such as leaden paralysis
• Psychomotor retardation
• Psychotic features and/or pathological guilt
• Lability of mood; irritability; psychomotor agitation; racing thoughts
Course of illness
• Early onset of first depression (<25 years)
• Multiple prior episodes (≥5 episodes)
Family history
• Positive family history of bipolar disorder
The CANMAT clinical guidelines for management of major depressive disorder in adults also note that one of the first steps in the assessment of poor response to an initial antidepressant treatment should involve re-evaluating the diagnosis (e.g., a missed diagnosis of bipolar disorder).
Option 1: Using Ocean
You can send the standalone RMS directly to individual patients during or after an appointment, with an Ocean messaging licence.
Estimated installation time: <30 mins
Option 2: Print the PDF
You can print the PDF below for the patient to complete, or add it manually to existing software.