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Shifts in the Care for Patients Presenting in Primary Care With Anxiety; Stepped Collaborative Care Parameters From More than a Decade

Published online by Cambridge University Press:  10 July 2015

L.G. Gidding ,
M.G. Spigt ,
J.G. Maris ,
O. Herijgers  and
G.-J. Dinant
L.G. Gidding*
Affiliation:
Department of Family Medicine, Maastricht University/CAPHRI School for Public Health and Primary Care P. Debyeplein 1, 6229 HA, Maastricht, P.O. Box 616, 6200MD Maastricht, The Netherlands
M.G. Spigt
Affiliation:
Department of Family Medicine, Maastricht University/CAPHRI School for Public Health and Primary Care P. Debyeplein 1, 6229 HA, Maastricht, P.O. Box 616, 6200MD Maastricht, The Netherlands
J.G. Maris
Affiliation:
Department of Family Medicine, Maastricht University/CAPHRI School for Public Health and Primary Care P. Debyeplein 1, 6229 HA, Maastricht, P.O. Box 616, 6200MD Maastricht, The Netherlands
O. Herijgers
Affiliation:
The Eindhoven Corporation of primary health care centres, Pastoriestraat 161, 5612 EK Eindhoven, P.O. Box 8736, 5605LS Eindhoven, The Netherlands
G.-J. Dinant
Affiliation:
Department of Family Medicine, Maastricht University/CAPHRI School for Public Health and Primary Care P. Debyeplein 1, 6229 HA, Maastricht, P.O. Box 616, 6200MD Maastricht, The Netherlands
*
*Corresponding author. Tel.: +31 43 3882091; fax: +31 43 3619344. E-mail address: Luc.Gidding@maastrichtuniversity.nl (L.G. Gidding).
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Abstract

Background

The mental health burden on primary care is substantial and increasing. Anxiety is a major contributor. Stepped collaborative care (SCC) is implemented worldwide to improve patient outcomes, but long term real-world evaluations of SCC do not exist. Using routinely used electronic medical records from more than a decade, we investigated changes in anxiety prevalences, whether physicians made distinction between non-severe and severe anxiety, and whether these groups were referred and treated differently, both non-pharmacologically and pharmacologically.

Methods

Retrospective assessment of anxiety care parameters recorded by 54 general practitioners between 2003 and 2014, in the electronic medical records of a dynamic population of 49,841–69,413 primary care patients.

Results

Substantial shifts in anxiety care parameters have occurred. The prevalence of anxiety symptoms doubled to 0.9% and of anxiety disorders almost tripled to 1.1%. Use of ICPC codes seemed comprehensive and use of instruments to support in anxiety level differentiation increased to 13% of anxiety symptom and 7% of anxiety disorder patients in 2014. Minimal interventions were used more frequently, especially for anxiety symptoms (OR 21 [95% CI 5.1–85]). The antidepressant prescription rates decreased significantly for anxiety symptoms (OR 0.5 [95% CI 0.4–0.8]) and anxiety disorders (OR 0.6 [95% CI 0.4–0.8]). More patients were referred to psychologists and psychiatrists.

Conclusions

We found shifts in anxiety care parameters that follow the principles of SCC. Future primary care research should comprehensively assess the use of the SCC range of therapeutic options, tailored to patients with all different anxiety severity levels.

Keywords

Anxiety disordersPrimary health careDisease managementElectronic medical recordsStepped collaborative care
Type
Original article
Information
European Psychiatry , Volume 30 , Issue 6 , September 2015 , pp. 770 - 777
Copyright
Copyright © Elsevier Masson SAS 2015

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