Abstract
Anxiety disorders are common, yet under diagnosed, in primary care settings. Many patients with anxiety and other psychiatric disorders do not seek care in mental health care settings. An integrated primary care/mental health model offers one approach to improving outcomes for patients with anxiety disorders. This model has been researched for the treatment of depression with positive results but has not been well studied for the treatment of anxiety disorders. We describe the results of care for a cohort of adult patients with Generalized Anxiety Disorder (GAD) and clinically significant anxiety secondary to Major Depressive Disorder (MDD) treated in an integrated model. Compared to a matched cohort of adults treated in a primary care setting with usual care, the intervention cohort experienced significantly improved reduction in symptoms of anxiety at 6 months. The intervention cohort also was significantly more satisfied with care.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
REFERENCES
Franco J: The added costs of depression to medical care. Pharmacoeconomics, 7:284-297, 1995.
Angst J, Merikangas KR, Preisig M: Subthreshold syndromes of depression and anxiety in the community. Journal of Clinical Psychiatry, 58 suppl. 8: 6-10, 1997.
Valente SM: Diagnosis and treatment of panic disorder and generalized anxiety in primary care. Nurse Practicioner, 21(8): 26, 32-4, 37-8, 1996.
Zajecka J: Importance of establishing the diagnosis of persistent anxiety. Journal of Clinical Psychiatry, 58 suppl. 3:9-13, 1997.
Nisenson LG, Pepper CM, Schwenk TL, et al.: The nature and prevalence of anxiety disorders in primary care. General Hospital Psychiatry, 20(1):21-28, 1998.
Ravindran AV, Judge R, Hunter BN, et al.: A double-blind multicenter study in primary care comparing paroxetine and clomipramine in patients with depression and associated anxiety. Journal of Clinical Psychiatry, 58(3), 112-118, 1998.
Lecrubier Y, Ustun TB: Panic and depression: a world wide primary care perspective. International Clinical Psychopharmocology, 13 suppl 4; 7-11, 1998.
Simon et al.: Health care costs associated with depressive and anxiety disorders in primary care. American Journal of Psychiatry, 152:352-356, 1995.
Leon AC, Olfson M, Portera L: Service utilization and expenditures for the treatment of panic disorder. General Hospital Psychiatry, 19(2):82-88, 1997.
Fifer S, et al.: Untreated anxiety among adult primary care patients in a health maintenance organization. Archives of General Psychiatry, 51:740-750, 1994.
Katon W: Collaborative care: Patient satisfaction, outcomes, and medical cost-offset. Family Systems Medicine, 13:351-365, 1996.
Wells, et al.: Detection of depressive disorder for patients receiving prepaid or fee-for-service care. JAMA, 262:3298-3302, 1989.
Barsky A, Borus: Somatization and medicalization in the era of managed care. JAMA, 274:1931-1933, 1995.
Schulberg HC: Clinical trials of primary care treatment for major depression: issues in design, recruitment and treatment. International Journal of Psychiatry in Medicine, 23:29-42, 1993.
Schulberg HC: Mental disorders in the primary care setting: research priorities for the 1990's. General Hospital Psychiatry, 13:156-164, 1991.
Sturm R, Wells K: How can the care for depression become more cost-effective? JAMA, 273:51-58, 1995.
McDaniel S, Campbell T, Seaburn D: Priniciples for collaboration between health and mental health providers in primary care. Family Systems Medicine, 13:283-298, 1996.
Pace T: Psychological consultation with primary care physicians: Obstacles and opportunities in the medical setting. Professional Psychology Research and Practice, 26:123-131, 1995.
Bray J, Rogers J: Linking psychologists and family physicians for collaborative practice. Professional Psychology Research and Practice, 26:132-138, 1995.
Katon W, Gonzales J: A review of randomized trials of psychiatric consultation-liaison studies in primary care. Psychosomatic Medicine, 35:268-278, 1995.
Katon W, et al: Collaborative management to achieve treatment guidelines: Impact on depression in primary care. JAMA, 273:1026-1031, 1995.
Mumford E, Schlesinger H, Glass G, et al: A new look at evidence about reduced cost of medical utilization following mental health treatment. American Journal of Psychiatry, 141:1145-1158, 1984.
Pace T, Chaney J, Mullins L, et al: Psychological consultation with primary care physicians: Obstacles and opportunities in the medical setting. Professional Psychology Research and Practice, 26:123-131, 1995.
Pallak M, Cummings N, Dorken H, et al: Managed mental health, medicaid, and medical cost offset. New Directions for Mental Health, 59:27-40, 1993.
Leahy D, Galbreath L, Powell, et al: Medical family therapy casebook: A case of collaboration HMO style. Family Systems Medicine, 12:437-439, 1994.
Muchnick S, Davis B, Getzinger A, et al: Collaboration between family therapy and health care: An internship experience. Family Systems Medicine, 11:271-279, 1993.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Price, D., Beck, A., Nimmer, C. et al. The Treatment of Anxiety Disorders in a Primary Care HMO Setting. Psychiatr Q 71, 31–45 (2000). https://doi.org/10.1023/A:1004662600803
Issue Date:
DOI: https://doi.org/10.1023/A:1004662600803