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Am Fam Physician. 2006;73(11):2060

Approximately 30 million persons in the United States have suffered from an anxiety disorder at some point during their lives. An estimated 12 to 22 percent of patients seen in primary care offices have symptoms related to anxiety. Patients who do have anxiety disorders tend to use expensive medical services at a higher rate than those who do not. The prevalence of panic disorder in the general population is 4 to 6 percent. Five to 19 percent of patients are diagnosed with generalized anxiety disorder (GAD). Despite the availability of treatments for these disorders, patients with one or both of them have poorer than expected outcomes. Various studies have shown that there are many reasons for these poor outcomes. Rollman and colleagues evaluated a telephone-based collaborative care model with primary care physicians in the treatment of patients with panic disorder and GAD.

The trial was a randomized controlled study of patients from four primary care practices that shared a common electronic medical records system. Patients 18 to 64 years of age who agreed to participate were screened for the presence of anxiety symptoms using a brief validated patient questionnaire. Those who screened positive completed two more extensive anxiety questionnaires. Patients who were identified as having anxiety disorder were then randomized to receive an intervention or usual care. The intervention included care by two non–mental health professionals. These individuals gave the participants psychoeducation, monitored treatment response, and informed physicians of their patients' care preferences and progress. Patient assessments were done by phone at baseline and at two, four, eight, and 12 months. The assessments included anxiety and depressive symptoms, mental-health–related quality of life, and employment status.

There were 191 patients who met the inclusion criteria for the study, with 116 in the intervention group and 75 in the usual care group. At the end of the 12 months, the individuals who received intervention reported significantly less anxiety and depressive symptoms compared with the usual care group. In addition, those in the intervention group had improved mental-health–related quality of life and more hours worked per week compared with the usual care group. If participants were working at the beginning of the study, those in the intervention group were more likely to still be working at six months than those who received usual care (94 versus 79 percent, P = .04).

The authors conclude that a telephone-based collaborative care model for patients with panic disorder and GAD was more effective than usual care. They added that the intervention was effective within the normal practice conditions in the primary care setting. These findings demonstrate that this model could be used in areas lacking a mental health subspecialist.

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