How to handle anxiety disorders in primary care: Suggestions from a trial
A Dutch trial published in Psychotherapy and Psychosomatics (P&P) has tested how treatments of anxiety disorders may perform in primary care.
Collaborative stepped care (CSC) may be an appropriate model to provide evidence-based treatment for anxiety disorders in primary care. In a cluster randomized controlled trial, the effectiveness of CSC compared to care as usual (CAU) for adults with panic disorder (PD) or generalized anxiety disorder (GAD) in primary care was evaluated.
Thirty-one psychiatric nurses who provided their services to 43 primary care practices in the Netherlands were randomized to deliver CSC or CAU. CSC was provided by the psychiatric nurses (care managers) in collaboration with the general practitioner and a consultant psychiatrist.
The intervention consisted of 3 steps, namely guided self-help, cognitive behavioral therapy and antidepressants. Anxiety symptoms were measured with the Beck Anxiety Inventory (BAI) at baseline and after 3, 6, 9 and 12 months. We recruited 180 patients with a DSM-IV diagnosis of PD or GAD, of whom 114 received CSC and 66 received usual primary care. CSC resulted superior to CAU in BAI scores from baseline to follow ups. CSC, with guided self-help as a first step, was more effective than CAU for primary care patients with PD or GAD.