Article2004

Quality of Care for Primary Care Patients With Anxiety Disorders

Murray B. Stein · Cathy Donald Sherbourne · Michelle Genevieve Craske · Adrienne J. Means‐Christensen · Alexander Bystritsky · Wayne J. Katon +2 more

192 citations0/0 files storedAmerican Journal of Psychiatry

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Mental Health Treatment and Access Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes Primary Care and Health Outcomes

Abstract

OBJECTIVE: This study evaluated quality of care for primary care patients with anxiety disorders in university-affiliated outpatient clinics in Los Angeles, San Diego, and Seattle. METHOD: Three hundred sixty-six primary care outpatients who were diagnosed with panic disorder, generalized anxiety disorder, social phobia, and/or posttraumatic stress disorder (with or without major depression) were surveyed about care received in the prior 3 months. Quality indicators were mental health referral, anxiety counseling, and use of appropriate antianxiety medication during the previous 3 months. RESULTS: Approximately one-third of patients with anxiety disorders had received counseling from their primary care provider in the prior 3 months. Fewer than 10% had receiving counseling from a mental health professional that included multiple elements of cognitive behavior therapy. Approximately 40% had received appropriate antianxiety medications in the previous 3 months, although only 25% had received them at a minimally adequate dose and duration. Overall, fewer than one in three patients had received either psychotherapy or pharmacotherapy that met a criterion for quality care. In multivariate analyses, patients with comorbid depression and/or medical illness were more likely-and patients from ethnic minorities were less likely-to receive appropriate antianxiety medications. CONCLUSIONS: Rates of quality care for anxiety disorders are moderate to low in university-affiliated primary care practices. Although an appropriate type of pharmacotherapy was frequently used, it was often of inadequate duration. Cognitive behavior therapy was markedly underused. These findings emphasize the need for practice guidelines and implementation of quality improvement programs for anxiety disorders in primary care.

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References

1994Lifetime and 12-Month Prevalence of DSM-III-R Psychiatric Disorders in the United States 2003The Epidemiology of Major Depressive Disorder 2002Collaborative Care Management of Late-Life Depression in the Primary Care Setting 1993The de Facto US Mental and Addictive Disorders Service System 1995Collaborative management to achieve treatment guidelines. Impact on depression in primary care 1999The Economic Burden of Anxiety Disorders in the 1990s 2002Screening for Depression in Adults: A Summary of the Evidence for the U.S. Preventive Services Task Force 2001The Quality of Care for Depressive and Anxiety Disorders in the United States

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2018Behavioral Experiments for Intolerance of Uncertainty: Challenging the Unknown in the Treatment of Generalized Anxiety Disorder 2012Dissemination of Evidence-Based Practices for Anxiety Disorders in Wyoming 2011Rates of Detection of Mood and Anxiety Disorders in Primary Care 2007Psychiatric Treatment in Primary Care Patients With Anxiety Disorders: A Comparison of Care Received From Primary Care Providers and Psychiatrists

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