A randomized trial to. improve the quality of treatment for panic and generalized anxiety disorders in primary care

Context: Panic disorder and generalized anxiety disorder are prevalent in primary care, associated with poor functional outcomes, and are often unrecognized and ineffectively treated by primary care physicians. Objective: To examine whether telephone-based collaborative care for panic and generalized anxiety disorders improves clinical and functional outcomes more than the usual care provided by primary care physicians. Design: Randomized controlled trial. Setting: Four Pittsburgh area primary care practices linked by a common electronic medical record system. Patients: A total of 191 adults aged 18 to 64 years with panic and/or generalized anxiety disorder who were recruited from July 2000 to April 2002. Intervention: Patients were randomly assigned to a telephone-based care management intervention (n = 116) or to notification alone of the anxiety disorder to patients and their physicians (usual care, n = 75). The intervention involved non-mental health professionals who provided patients with psycho education, assessed preferences for guideline-based care, monitored treatment responses, and informed physicians of their patients' care preferences and progress via an electronic medical record system under the direction of study investigators. Main Outcome Measures: Independent blinded assessments of anxiety and depressive symptoms, mental health-related quality of life, and employment status at baseline, 2-, 4-, 8-, and 12-month follow-up. Results: At 12-month follow-up, intervention patients reported reduced anxiety (effect size [ES], 0.33-0.38; 95% confidence interval [CI], 0.04 to 0.67; P <=.02) and depressive symptoms (ES, 0.35; 95% Cl, 0.25-0.46; P=.03); improved mental health-related quality of life (ES, 0.39; 95% Cl, 0.10 to 0.68; P=.01); and larger. improvements relative to baseline in hours worked per week (5.7; 95% Cl, 0.1 to 11.3; P=.05) and fewer work days absent in the past month (-2.6; 95% Cl, -4.8 to -0.3;P=.03) than usual care patients. If working at baseline, more intervention patients than usual care patients remained working at 12-month follow-up (94% vs 79% [15% absolute difference, 0.7%-28.6%]; P=.04). Conclusions: Telephone-based collaborative care for panic disorder and generalized anxiety disorder is more effective than usual care at improving anxiety symptoms, health-related quality of life, and work-related outcomes.