Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-10-29T22:19:41.573Z Has data issue: false hasContentIssue false
  • English
  • Français

Evidence-based Guidelines for Anxiety Disorders: Can They Improve Clinical Outcomes?

Published online by Cambridge University Press:  07 November 2014

David S. Baldwin
David S. Baldwin*
Affiliation:
Dr. Baldwin is reader in psychiatry in the Department of Psychiatry at, Royal South Hants Hospital in Southampton, United Kingdom
*
David S. Baldwin, MB, BS, DM, FRCPsych, University Department of Psychiatry, Royal South Hants Hospital, Southampton, SO14 0YG, UK; Tel: +44-2380-825533; Fax: +44-2380-234243; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Evidence-based medicine (EBM) enables clinicians to justify decision making, enhances the quality of medical practice, identifies unanswered research questions, and ensures the efficient practice of medicine. Implementation of evidence-based mental health programs requires education, time, and improved effort by administration, regulatory, and clinical professionals. Essential to these efforts are consistent incentives for change, effective training materials, and clear clinical guidelines. Guidelines exist within the framework of EBM. Good guidelines are simple, specific, and user friendly, focus on key clinical decisions, are based on research evidence, and present evidence and recommendations in a concise and accessible format. Potential limitations of guidelines to improve clinical outcomes in anxiety disorders are the widespread distribution of anxiety symptoms in primary care, health inequalities across patient groups, persistent misconceptions regarding psychotropic drugs, and low confidence in using simple psychological treatments. Clinical guidelines generally specify therapeutic areas covered and not covered, but often there is no mention of cost or cost effectiveness of treatment. Guidelines can inform clinical decision making, but administrators of drug formularies may regard themselves as being primarily responsible for limiting costs and access to certain medications, even if these decisions are at odds with guideline recommendations.

Type
Research Article
Information
CNS Spectrums , Volume 11 , Issue S12 , 2006 , pp. 34 - 39
Copyright
Copyright © Cambridge University Press 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Drake, RE, Torrey, WC, McHugo, GJ. Strategies for implementing evidence-based practices in routine mental health settings. Evid Based Ment Health. 2003;6:6–7.CrossRefGoogle ScholarPubMed
2.Wittchen, HU, Lieb, R, Pfister, H, Schuster, P. The waxing and waning of mental disorders: evaluating the stability of syndromes of mental disorders in the population. Compr Psychiatry. 2000;41:122–132.CrossRefGoogle ScholarPubMed
3.Yonkers, KA, Bruce, SE, Dyck, IR, Keller, MB. Chronicity, relapse, and illness-course of panic disorder, social phobia, and generalized anxiety disorder: Findings in men and women from 8 years of follow-up. Depress Anxiety. 2003;17:173–179.CrossRefGoogle ScholarPubMed
4.Roose, SP. Depression, anxiety, and the cardiovascular system: the psychiatrist's perspective. J Clin Psychiatry. 2001;62(suppl 8):19–22.Google ScholarPubMed
5.Maina, G, Albert, U, Bogetto, F. Relapses after discontinuation of drug associated with increased resistance to treatment in obsessive-compulsive disorder. Int Clin Psychopharmacol. 2001;16:33–38.CrossRefGoogle ScholarPubMed
6.Stein, MB, Sherbourne, CD, Craske, MG, et al.Quality of care for primary care patients with anxiety disorders. Am J Psychiatry. 2004;161:2230–2237.CrossRefGoogle ScholarPubMed
7.Stahl, SM, Grady, MM. Differences in mechanism of action between current and future antidepressants. J Clin Psychiatry. 2003;64(suppl 13):13–17.Google ScholarPubMed
8.Wong, ML, Licinio, J. From monoamines to genomic targets: a paradigm shift for drug discovery in depression. Nat Rev Drug Discov. 2004;3:136–151.CrossRefGoogle ScholarPubMed
9.Sackett, DL, Rosenberg, WM, Gray, JA, Haynes, RB, Richardson, WS. Evidence based medicine: what it is and what it isn't. BMJ. 1996;312:71–72.CrossRefGoogle ScholarPubMed
10.Jackson, R, Feder, G. Guidelines for clinical guidelines. BMJ. 1998;317:427–428.CrossRefGoogle ScholarPubMed
11.Field, MJ, Lohr, KN. Guidelines for Clinical Practice: From Development to Use. Washington, DC: National Academies Press; 1992.Google Scholar
12.Hunkeler, EM, Meresman, JF, Hargreaves, WA, et al.Efficacy of nurse telehealth care and peer support in augmenting treatment of depression in primary care. Arch Fam Med. 2000;9:700–708.CrossRefGoogle ScholarPubMed
13.Katon, W, Von Korff, M, Lin, E, et al.Collaborative management to achieve treatment guidelines. Impact on depression in primary care. JAMA. 1995;273:1026–1031.CrossRefGoogle ScholarPubMed
14.Katon, W, Von Korff, M, Lin, E, et al.Stepped collaborative care for primary care patients with persistent symptoms of depression: a randomized trial. Arch Gen Psychiatry. 1999;56:1109–1115.CrossRefGoogle ScholarPubMed
15.Katzelnick, DJ, Simon, GE, Pearson, SD, et al.Randomized trial of a depression management program in high utilizers of medical care. Arch Fam Med. 2000;9:345–351.CrossRefGoogle ScholarPubMed
16.Peveler, R, George, C, Kinmonth, AL, Campbell, M, Thompson, C. Effect of antidepressant drug counselling and information leaflets on adherence to drug treatment in primary care: randomised controlled trial. BMJ. 1999;319:612–615.CrossRefGoogle ScholarPubMed
17.Rost, K, Nutting, P, Smith, J, Werner, J, Duan, N. Improving depression outcomes in community primary care practice: a randomized trial of the quEST intervention. Quality Enhancement by Strategic Teaming. J Gen Intern Med. 2001;16:143–149.CrossRefGoogle ScholarPubMed
18.Wells, KC, Pelham, WE, Kotkin, RA, et al.Psychosocial treatment strategies in the MTA study: rationale, methods, and critical issues in design and implementation. J Abnorm Child Psychol. 2000;28:483–505.CrossRefGoogle ScholarPubMed
19.Trivedi, MH, Rush, AJ, Crismon, ML, et al.Clinical results for patients with major depressive disorder in the Texas Medication Algorithm Project. Arch Gen Psychiatry. 2004;61:669–680.CrossRefGoogle ScholarPubMed
20.Thomas, HV, Lewis, G, Watson, M, et al.Computerised patient-specific guidelines for management of common mental disorders in primary care: a randomised controlled trial. Br J Gen Pract. 2004;54:832–837.Google ScholarPubMed
21.van Boeijen, CA, van Oppen, P, van Balkom, AJ, et al.Treatment of anxiety disorders in primary care practice: a randomised controlled trial. Br J Gen Pract. 2005;55:763–769.Google ScholarPubMed
22.Croudace, T, Evans, J, Harrison, G, et al.Impact of the ICD-10 Primary Health Care (PHC) diagnostic and management guidelines for mental disorders on detection and outcome in primary care. Cluster randomised controlled trial. Br J Psychiatry. 2003;182:20–30.CrossRefGoogle ScholarPubMed
23.Dowrick, C, Buchan, I. Twelve month outcome of depression in general practice: does detection or disclosure make a difference? BMJ. 1995;311:1274–1276.CrossRefGoogle ScholarPubMed
24.Thompson, C, Kinmonth, AL, Stevens, L, et al.Effects of a clinical-practice guideline and practice-based education on detection and outcome of depression in primary care: Hampshire Depression Project randomised controlled trial. Lancet. 2000;355:185–191.CrossRefGoogle ScholarPubMed
25.Kendrick, T. Why can't GPs follow guidelines on depression? We must question the basis of the guidelines themselves. BMJ. 2000;320:200–201.CrossRefGoogle ScholarPubMed
26.Kendrick, T, Peveler, R, Longworth, L, et al.Cost-effectiveness and cost-utility of tricyclic antidepressants, selective serotonin reuptake inhibitors and lofepramine: randomised controlled trial. Br J Psychiatry. 2006;188:337–345.CrossRefGoogle ScholarPubMed
27. Senate Bill 329. Oregon State Legislature Web site. Available at: http://www.leg.state.or.us/05reg/measures/sb0300.dir/sb0329.intro.html. Accessed April 19, 2006.Google Scholar
28. Oregon Health and Science University. Drug Effectiveness Review Project. Available at: http://www.ohsu.edu/drugeffectiveness/. Accessed April 19, 2006.Google Scholar
29. State of Oregon Department of Administrative Services. Office for Oregon Health Policy and Research Prescription Drug Program. Available at: http://egov.oregon.gov/DAS/OHPPR/OPDP/docs/OPDPadminrules.pdf. Accessed April 19, 2006.Google Scholar
30.Gartlehner, G, Hansen, RA, Kahwati, L, Lohr, KN, Gaynes, B, Carey, T. Drug Class Review on Second Generation Antidepressants. [Oregon Health and Science University Web site]. March 2006. Available at: http://www.ohsu.edu/drugeffectiveness/reports/documents/Antidepressants%20Final%Report%20Update%202.pdf. Accessed April 19, 2006.Google Scholar