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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: [email protected] (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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References

Alonso, J., Angermeyer, M.C., Bernert, S., Bruffaerts, R., Brugha, T.S., Bryson, H., et al.Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand Suppl 2004;420:21–27.Google Scholar
Ansseau, M., Fischler, B., Dierick, M., Mignon, A., Leyman, S.Prevalence and impact of generalized anxiety disorder and major depression in primary care in Belgium and Luxemburg: the GADIS study. Eur Psychiatry 2005;20(3):229–235.CrossRefGoogle ScholarPubMed
Archer, J., Bower, P., Gilbody, S., Lovell, K., Richards, D., Gask, L., et al.Collaborative care for depression and anxiety problems. Cochrane Database Syst Rev 2012;10:CD006525.Google ScholarPubMed
Bauer, A.M., Azzone, V., Goldman, H.H., Alexander, L., Unutzer, J., Coleman-Beattie, B., et al.Implementation of collaborative depression management at community-based primary care clinics: an evaluation. Psychiatr Serv 2011;62(9):1047–1053.CrossRefGoogle ScholarPubMed
Baxter, A.J., Scott, K.M., Vos, T., Whiteford, H.A.Global prevalence of anxiety disorders: a systematic review and meta-regression. Psychol Med 2013;43(5):897–910.CrossRefGoogle ScholarPubMed
Bet, P.M., Hugtenburg, J.G., Penninx, B.W., Balkom, A.V., Nolen, W.A., Hoogendijk, W.J.Treatment inadequacy in primary and specialized care patients with depressive and/or anxiety disorders. Psychiatry Res 2013;210(2):594–600.CrossRefGoogle ScholarPubMed
Braam, C., van Oostrom, S.H., Terluin, B., Vasse, R., de Vet, H.C., Anema, J.R.Validation study of a distress screener. J Occup Rehabil 2009;19(3):231–237.CrossRefGoogle ScholarPubMed
de Graaf, R., ten Have, M., van Gool, C., van Dorsselaer, S.Prevalence of mental disorders and trends from 1996 to 2009. Results from the Netherlands Mental Health Survey and Incidence Study-2. Soc Psychiatry Psychiatr Epidemiol 2012;47(2):203–213.CrossRefGoogle ScholarPubMed
Fassaert, T., Nielen, M., Verheij, R., Verhoeff, A., Dekker, J., Beekman, A., et al.Quality of care for anxiety and depression in different ethnic groups by family practitioners in urban areas in the Netherlands. Gen Hosp Psychiatry 2010;32(4):368–376.CrossRefGoogle ScholarPubMed
Fernandez, A., Haro, J.M., Martinez-Alonso, M., Demyttenaere, K., Brugha, T.S., Autonell, J., et al.Treatment adequacy for anxiety and depressive disorders in six European countries. Br J Psychiatry 2007;190:172–173.CrossRefGoogle ScholarPubMed
Gidding, L.G., Spigt, M.G., Dinant, G.-J.Stepped collaborative depression care: primary care results before and after implementation of a stepped collaborative depression programme. Fam Pract 2014;31(2):180–192.CrossRefGoogle ScholarPubMed
Grandes, G., Montoya, I., Arietaleanizbeaskoa, M.S., Arce, V., Sanchez, A.The burden of mental disorders in primary care. Eur Psychiatry 2011;26(7):428–435.CrossRefGoogle ScholarPubMed
Hassink-Franke, L.J., Terluin, B., Van Heest, F.B., Hekman, J., Van Marwijk, H., Van Avendonk, M.J.NHG-Standaard Angst: tweede herziening. Huisarts Wetenschap 2012;55(2):68–77. [NHG guideline on Anxiety: second revision].Google Scholar
Johansson, R., Carlbring, P., Heedman, A., Paxling, B., Andersson, G.Depression, anxiety and their comorbidity in the Swedish general population: point prevalence and the effect on health-related quality of life. Peer J 2013;1:e98.CrossRefGoogle ScholarPubMed
Joling, K.J., Van Marwijk, H.W., Piek, E., Van der Horst, H.E., Penninx, B.W., Verhaak, P., et al.Do GPs’ medical records demonstrate a good recognition of depression? A new perspective on case extraction. J Affect Disord 2011;133(3):522–527.CrossRefGoogle ScholarPubMed
Katon, W., Unutzer, J.Collaborative care models for depression: time to move from evidence to practice. Arch Intern Med 2006;166(21):2304–2306.CrossRefGoogle ScholarPubMed
Katon, W., Von Korff, M., Lin, E., Simon, G., Walker, E., Unutzer, J., et al.Stepped collaborative care for primary care patients with persistent symptoms of depression: a randomized trial. Arch Gen Psychiatry 1999;56(12):1109–1115.CrossRefGoogle ScholarPubMed
Katon, W., Unutzer, J., Wells, K., Jones, L.Collaborative depression care: history, evolution and ways to enhance dissemination and sustainability. Gen Hosp Psychiatry 2010;32(5):456–464.CrossRefGoogle ScholarPubMed
Kroenke, K., Spitzer, R.L., Williams, J.B., Monahan, P.O., Lowe, B.Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med 2007;146(5):317–325.CrossRefGoogle Scholar
Lewis, C., Pearce, J., Bisson, J.I.Efficacy, cost-effectiveness and acceptability of self-help interventions for anxiety disorders: systematic review. Br J Psychiatry 2012;200(1):15–21.CrossRefGoogle ScholarPubMed
Martin-Merino, E., Ruigomez, A., Wallander, M.A., Johansson, S., Garcia-Rodriguez, L.A.Prevalence, incidence, morbidity and treatment patterns in a cohort of patients diagnosed with anxiety in UK primary care. Fam Pract 2010;27(1):9–16.CrossRefGoogle Scholar
McEvoy, P.M., Grove, R., Slade, T.Epidemiology of anxiety disorders in the Australian general population: findings of the 2007 Australian National Survey of Mental Health and Wellbeing. Aust N Z J Psychiatry 2011;45(11):957–967.CrossRefGoogle ScholarPubMed
Munk-Jorgensen, P., Allgulander, C., Dahl, A.A., Foldager, L., Holm, M., Rasmussen, I., et al.Prevalence of generalized anxiety disorder in general practice in Denmark, Finland, Norway, and Sweden. Psychiatr Serv 2006;57(12):1738–1744.CrossRefGoogle ScholarPubMed
National Guideline C. Generalised anxiety disorder and panic disorder (with or without agoraphobia) in adults. Management in primary, secondary and community care Rockville MD: Agency for Healthcare Research and Quality (AHRQ) 2011. Available from: http://www.guideline.gov/content.aspx?id=34280.Google Scholar
Newcombe, R.Two-sided confidence intervals for the single proportion: comparison of seven methods. Stat Med 1998;17:857–872.3.0.CO;2-E>CrossRefGoogle ScholarPubMed
NICE, Anxiety disorders. NICE quality standard 53. 2014 National Institute for Health and Care Excellence 1–40.Google Scholar
Oosterbaan, D.B., Verbraak, M.J., Terluin, B., Hoogendoorn, A.W., Peyrot, W.J., Muntingh, A., et al.Collaborative stepped care v. care as usual for common mental disorders: 8-month, cluster randomised controlled trial. Br J Psychiatry 2013;203:132–139.CrossRefGoogle Scholar
Penninx, B.W., Nolen, W.A., Lamers, F., Zitman, F.G., Smit, J.H., Spinhoven, P., et al.Two-year course of depressive and anxiety disorders: results from the Netherlands Study of Depression and Anxiety (NESDA). J Affect Disord 2011;133(1–2):76–85.CrossRefGoogle Scholar
Prins, M.A., Verhaak, P.F., Hilbink-Smolders, M., Spreeuwenberg, P., Laurant, M.G., van der Meer, K., et al.Outcomes for depression and anxiety in primary care and details of treatment: a naturalistic longitudinal study. BMC Psychiatry 2011;11:180.CrossRefGoogle ScholarPubMed
Richards, D.A.Stepped care: a method to deliver increased access to psychological therapies. Can J Psychiatry 2012;57(4):210–215.CrossRefGoogle ScholarPubMed
Richards, D.A., Borglin, G.Implementation of psychological therapies for anxiety and depression in routine practice: two year prospective cohort study. J Affect Disord 2011;133(1–2):51–60.CrossRefGoogle ScholarPubMed
Richards, D.A., Bower, P., Pagel, C., Weaver, A., Utley, M., Cape, J., et al.Delivering stepped care: an analysis of implementation in routine practice. Implement Sci 2012;7:3.CrossRefGoogle ScholarPubMed
Richards, D.A., Bower, P., Pagel, C., Weaver, A., Utley, M., Cape, J., et al.Delivering stepped care: an analysis of implementation in routine practice. Implement Sci 2012;7(1):3.CrossRefGoogle ScholarPubMed
Richtlijnwerkgroep Multidisciplinaire richtlijnen Angststoornissen en Depressie. Richtlijnherziening Multidisciplinaire richtlijn Angststoornissen: richtlijn voor de diagnostiek, behandeling en begeleiding van volwassen cliënten met een angststoornis [Multidisciplinary guideline anxiety disorders: guideline for diagnostics, treatment and counseling of adult clients with an anxiety disorder: first revision]. Utrecht: Trimbos institute; 2009.Google Scholar
Rubio-Valera, M., Fernandez, A., Luciano, J.V., Hughes, C.M., Pinto-Meza, A., Moreno-Kustner, B., et al.Psychotropic prescribing in Catalonia: results from an epidemiological study. Fam Pract 2012;29(2):154–162.CrossRefGoogle ScholarPubMed
Rucci, P., Piazza, A., Menchetti, M., Berardi, D., Fioritti, A., Mimmi, S., et al.Integration between primary care and mental health services in italy: determinants of referral and stepped care. Int J Family Med 2012;2012:507464.CrossRefGoogle ScholarPubMed
Seekles, W., van Straten, A., Beekman, A., van Marwijk, H., Cuijpers, P.Stepped care treatment for depression and anxiety in primary care: a randomized controlled trial. Trials 2011;12(1):171.CrossRefGoogle ScholarPubMed
Seekles, W., van Straten, A., Beekman, A., van Marwijk, H., Cuijpers, P.Stepped care treatment for depression and anxiety in primary care. a randomized controlled trial. Trials 2011;12:171.CrossRefGoogle ScholarPubMed
Sheldon, T.Reserve antidepressants for cases of severe depression, Dutch doctors are told. BMJ 2012;e4211:344.Google Scholar
Stein, M.B., Roy-Byrne, P.P., Craske, M.G., Campbell-Sills, L., Lang, A.J., Golinelli, D., et al.Quality of and patient satisfaction with primary health care for anxiety disorders. J Clin Psychiatry 2011;72(7):970–976.CrossRefGoogle ScholarPubMed
Terluin, B., Van Marwijk, H.W., Ader, H.J., De Vet, H.C., Penninx, B.W., Hermens, M.L., et al.The Four-Dimensional Symptom Questionnaire (4DSQ): a validation study of a multidimensional self-report questionnaire to assess distress, depression, anxiety and somatization. BMC Psychiatry 2006;6:34.CrossRefGoogle ScholarPubMed
Terluin, B., Brouwers, E.P., Van Marwijk, H.W., Verhaak, P.F., Van der Horst, H.E.Detecting depressive and anxiety disorders in distressed patients in primary care; comparative diagnostic accuracy of the Four-Dimensional Symptom Questionnaire (4DSQ) and the Hospital Anxiety and Depression Scale (HADS). BMC Fam Pract 10 2009 58.CrossRefGoogle Scholar
Tylee, A., Walters, P.Underrecognition of anxiety and mood disorders in primary care: why does the problem exist and what can be done?. J Clin Psychiatry 2007;68(Suppl. 2):27–30.Google Scholar
Van Avendonk, M.J., Hassink-Franke, L.J., Terluin, B., Van Marwijk, H.W., Wiersma, T., Burgers, J.S.[Summary of the NHG practice guideline ‘Anxiety’]. Ned Tijdschr Geneeskd 2012;156(34):A4509.Google Scholar
Van Avendonk, M., Van Weel-Baumgarten, E., Van der Weele, G., Wiersma, T., Burgers, J.S.[Summary of the Dutch College of General Practitioners’ practice guideline ‘Depression’]. Ned Tijdschr Geneeskde 2012;156(38):A5101.Google Scholar
Van der Does, A.Manual for the Dutch Version of Beck Depression Inventory - second edition. Amsterdam; 2002.[Handleiding bij de Nederlandse versie van Beck Depression Inventory - second edition (BDI-II-NL)]Google Scholar
Van der Linden, M.W., De Bakker, G., Schellevis, D.F.Tweede Nationale Studie naar ziekten en verrichtingen in de huisartspraktijk. Klachten en aandoeningen in de bevolking en in de huisartspraktijk. Utrect/Bilthoven: NIVEL/RIVM; 2004.Google Scholar
Van Marwijk, H.W., Grundmeijer, H.G.L.M., Bijl, D., Van Gelderen, M.G., De Haan, M., Van Weel-Baumgarten, E.M., et al.NHGStandaard Depressieve stoornis: eerste herziening. Huisarts Wetenschap 2003;46(11):614–623. [NHG Standard Major Depressive Disorder: first revision].Google Scholar
Van Weel-Baumgarten, E., Van Gelderen, M.G., Grundmeijer, H., Licht-Strunk, E., Van Marwijk, H.W., Van Rijswijk, E., et al.NHG-Standaard Depressie (tweede herziening). Huisarts Wetenschap 2012;55(6):252–259. [NHG guideline on Major Depressive Disorder: second revision].Google Scholar
Weisberg, R.B., Beard, C., Moitra, E., Dyck, I., Keller, M.B.Adequacy of treatment received by primary care patients with anxiety disorders. Depress Anxiety 2014;31(5):443–450.CrossRefGoogle ScholarPubMed
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