The researchers report that telephone-based care for people with generalized anxiety disorder and panic disorder significantly improves both their symptoms of anxiety and depression and their mental health-related quality of life. The Pitt researchers also found the intervention results in fewer missed workdays and lower levels of emergency room usage.
This study is among the first to evaluate the efficacy of a telephone-based collaborative care intervention for anxiety disorders in a primary care setting, garnering results that could have far-reaching impact on how patients in all types of communities - urban, suburban and rural - can be helped. "Collaborative care" involves care managers who support patients by taking the time needed to familiarize the patients with their illnesses and treatment options while teaching self-management techniques and promoting adherence with recommended treatments according to evidence-based guidelines and under the direction of the patients' primary care physicians with specialist involvement when necessary. By providing support and monitoring progress, the use of care managers can result in much better outcomes for patients.
More than 30 million Americans have suffered from anxiety disorders at some point in their lives. Approximately 12 to 22 percent of patients present symptoms of anxiety-related distress to their primary care physicians. The direct and indirect costs of anxiety disorders have been estimated at $42 billion a year in the United States; 10 percent of those costs come from missed work days and other workplace costs. These facts establish the need for cost-effective and generalizable strategies for treating these patients.
"There has been a surge of interest in treating anxiety disorders and depression in the primary care setting, but we had few time-efficient and cost-effective ways to treat these disorders," said Bruce L. Rollman, M.D., M.P.H, associate professor of medicine and psychiatry at the University of Pittsburgh School of Medicine and lead author of the study. "We found that having non-mental health specialty care managers provide patients with information and support over the phone in collaboration with patients' primary care physicians was indeed a very effective way of improving patients' symptoms, quality of life and patterns of employment. Perhaps most importantly, this method can be used in a variety of settings and could prove extremely beneficial to underserved populations."
Researchers enrolled 191 adults between the ages of 18 and 64 years who presented with panic and/or generalized anxiety disorder at one of four primary care practices in the Pittsburgh area. The practices were all affiliated with the University of Pittsburgh Medical Center and included urban, suburban and rural family practices with university-affiliated physicians.
Patients were randomized to receive either their primary care physician's usual care for panic and generalized anxiety disorder or the telephone-based care management intervention. The telephone-based intervention used care managers who provided participants with psychoeducation about their anxiety disorders, discussed the participants' treatment preferences, monitored treatment responses, and relayed this information to the patients' primary care physicians via an electronic medical record system. Intervention patients received a median of 12 telephone contacts from their care managers over the course of twelve months.
At 12-month follow-up, those who participated in the telephone intervention were more likely to experience a decline in anxiety and depressive symptoms, less likely to visit the emergency room, less likely to miss work and able to work more hours than those receiving conventional care.
This study was funded by the National Institute of Mental Health.