Quality of and patient satisfaction with primary health care for anxiety disorders
Open accessAbstract
BACKGROUND: Most patients with anxiety disorders receive their care from primary care practitioners (PCPs). The purpose of this study was to evaluate quality of and patient satisfaction with primary health care for anxiety disorders. METHOD: A survey was performed among 1,004 outpatients with anxiety disorders (diagnosed according to DSM-IV) referred by their PCPs from 17 primary care clinical settings (3 of which were university-affiliated) in 4 regions of the United States for participation in the Coordinated Anxiety Learning and Management (CALM) study, a therapeutic trial. Participating research institutions were the University of Washington at Seattle, the University of California at San Diego and Los Angeles, and the University of Arkansas for Medical Sciences at Little Rock. Enrollment took place between June 2006 and April 2008. Patients were contacted by telephone after enrollment to provide information about previous care received (during the 6 months prior to referral) and satisfaction with that care. Quality-of-care indicators were self-reported type, dose, and duration of antianxiety medication treatment and self-reported psychotherapy with cognitive-behavioral therapy (CBT) elements. RESULTS: A total of 576 patients (57.4%) had received an appropriate antianxiety medication in the previous 6 months, but only 289 patients (29.4% of 983 who answered this question) had received the medication at adequate dose for at least 2 months. A total of 465 patients (46.3%) had received some counseling with at least 1 element of CBT, but only 213 patients (21.2%) had received counseling with a strong (3+ elements) CBT focus. Overall, 416 patients (41.4%) had received quality pharmacotherapy or psychotherapy, and 81 patients (8.1%) had received both. Only 432 patients (44.8% of 964 who answered this question) were at least somewhat satisfied with their mental health care. Receipt of quality psychotherapy was the sole positive predictor (adjusted odds ratio = 2.71; 95% CI, 1.94-3.80; P < .0005) of satisfaction with mental health care for anxiety. Moreover, there was a dose-response relationship between the number of CBT elements consistently delivered and satisfaction with care (test for trend, z = 4.06, P < .0005). CONCLUSIONS: Despite recognition of these patients' anxiety disorders and referral by their PCPs to an anxiety treatment study, fewer than half of the patients had in the prior 6 months received quality pharmacologic and/or psychosocial mental health care. Receipt of CBT-oriented, quality psychosocial (but not pharmacologic) care showed a strong dose-response relationship with satisfaction with mental health care.
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Treatment provided in primary care is most often pharmacological.
“Anxiety is undertreated in primary care, and treatment provided is most often pharmacological (Stein et al., 2011; Weisberg et al., 2014) despite most patients preferring behavioral treatment (McHugh et al., 2013).”
From Brief modular anxiety intervention for primary care: Hybrid I pilot randomized controlled trial of feasibility, acceptability, effectiveness, and implementation potential (2024) · cites this paper as Stein et al., 2011
The Results (Types and Quality of Care Received; page unavailable) report medication use in 57.4% of patients, compared with quality psychotherapy in 21.2%, supporting the claim if it contrasts medication with CBT-oriented treatment. But 92.5% reported receiving some counseling, so the paper does not establish that treatment overall was most often pharmacological. (LLM, conf=0.84)
Experimental — accuracy not yet measuredAnxiety is undertreated in primary care.
“Anxiety is undertreated in primary care, and treatment provided is most often pharmacological (Stein et al., 2011; Weisberg et al., 2014) despite most patients preferring behavioral treatment (McHugh et al., 2013).”
From Brief modular anxiety intervention for primary care: Hybrid I pilot randomized controlled trial of feasibility, acceptability, effectiveness, and implementation potential (2024) · cites this paper as Stein et al., 2011
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- Authors
- Stein, M. B., Roy-Byrne, P. P., Craske, M. G., Campbell-Sills, L., Lang, A. J., Golinelli, D., Rose, R. D., Bystritsky, A., Sullivan, G., & Sherbourne, C. D.
- Affiliations
- University of California San Diego (US)
- University of California, Los Angeles (US)
- University of Washington (US)
- University of Arkansas for Medical Sciences (US)
- RAND Corporation (US)
- Corresponding author
- Stein, Murray B.
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2011-02-22
- Volume
- 72
- Issue
- 07
- Pages
- 970-976
- ISSN
- 0160-6689 (ISSN-L)
- PMC
- PMC3111814
- OpenAlex
- W2072669374
- Cited by
- 100
- References
- 38
- Citations by year
- 2026: 2 · 2024: 5 · 2023: 3 · 2022: 5 · 2021: 8 · 2020: 13 · 2019: 7 · 2018: 14 · 2017: 7 · 2016: 12 · 2015: 6 · 2014: 5 · 2013: 6 · 2012: 5
- FWCI
- 7.42
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (U01MH057835, K24MH065324, K24MH064122, R01MH057835, K24MH64122, U01MH070022, U01MH070018, U01MH057858, U01MH058915)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- anxiety disorders, primary care, quality of care, patient satisfaction, anxiolytics, cognitive behavioral therapy, psychotherapy, medication dose, access to mental health care
- MeSH terms
- Adolescent, Adult, Aged, Anxiety Disorders, Combined Modality Therapy, Dose-Response Relationship, Drug, Female, Health Surveys, Humans, Male, Middle Aged, Phobic Disorders, Primary Health Care, Stress Disorders, Post-Traumatic, Anti-Anxiety Agents, Cognitive Behavioral Therapy, Panic Disorder, Patient Satisfaction, Evidence-Based Medicine, Quality Indicators, Health Care, Young Adult
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