January 1st, 2014

Anxiety patients get treated via primary care

Patients dealing with anxiety disorders in primary care appear to get treatment – although it sometimes takes years for it to happen – and this situation occurred less for minorities, according to a recent study by Brown University researchers.

The study, which appeared online in the Nov. 4 issue of the journal Depression and Anxiety, looked at the types of treatment for 534 patients with anxiety symptoms in primary care over five years at 15 sites in the Northeast (N.H., Mass., R.I. and Vt.).

“In a way this is almost a follow up to a paper that came out in 2007, when we really just talked about a point in time,” says lead author Risa Weisberg, Ph.D., associate professor of psychiatry and human behavior at the Warren Alpert Medical School of Brown University. “Are they getting any treatment at all? Now we were more interested in if the treatment they were getting is what we would consider standard of care.”

This study is one of the first on anxiety to look at care over a longer period of time, Weisberg says. Previous studies have focused on “one slice of time,” she says.

In this study, patients were interviewed at baseline, at six months, a year and then yearly for five years. The study found that at intake, 19 percent reported receiving appropriate medication and 14 percent reported receiving cognitive behavioral therapy. Overall, 28 percent of patients in the study reported receiving “potentially adequate anxiety treatment.” Those numbers improved over five years with 60 percent reporting they were receiving pharmacotherapy, 36 percent reporting they received psychotherapy, and overall, 69 percent reported receiving treatment. Primary care patients with Major Depressive Disorder, panic disorder with agoraphobia and those with Medicare/Medicaid were more likely to receive appropriate treatment, according to the study.

“When we look at the whole up to a five-year time space, we see the proportion of individuals go up to two-thirds who received potentially adequate care,” says Weisberg. “Eventually, more people get into more care and that’s good news.”

Researchers also looked at each year of treatment individually, finding that less than half of patients were getting adequate treatment, she says. “It looks like people are getting treatment, but not necessarily staying in care,” says Weisberg. “For psychotherapy-CBT types of treatment techniques, the principles are learn these new skills, and keep them over time. Pharmacotherapy looks a little piecemeal. Patients are not staying in care over the time.”

Ethnic minorities were also less likely to receive care, according to the study. “The take home of this study is that this looks better than the other studies but we still have a long way to go. One of those clear cases is when it comes to ethno-racial minorities,” Weisberg says.

Anxiety disorders are one of the most common mental health problems in the U.S., affecting about 30 percent of the population (lifetime prevalence), according to the research.

Patients with anxiety disorders are more likely to get treatment in primary care (internal or family medicine) and primary care doctors are doing a good job of prescribing the right medications and dosages, Weisberg says. “It’s not surprising that [patients] would get more pharmacotherapy, rather than psychotherapy,” she says.

There are psychotherapy treatments that work for anxiety disorders, Weisberg says, but doctors she has spoken with during her research have said they did not know private practice psychologists in the community. “For psychologists, making those connections with primary care providers is a key way not only to build your practice but to reach patients that need care.”

The study was funded by Pfizer Inc.

By Rivkela Brodsky

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