Phone-Based Primary Care Can Ease Anxiety, Mood Symptoms

A phone-based collaborative care program designed to treat panic and generalized anxiety disorders in primary care was found to be much more effective in lowering symptoms and increasing health-related quality of life than typical care, according to new research at the University of Pittsburgh School of Medicine.

Collaborative care, or integrative care, refers to primary care treatment that also offers mental health, behavioral health, and substance use therapies.

“While dozens of clinical trials have demonstrated the effectiveness of collaborative care for treating depression in primary care, comparatively few have addressed anxiety, despite their similar prevalence and adverse impact on health-related quality of life and excess utilization of health services,” said Bruce L. Rollman, M.D., M.P.H., professor of medicine and director of Pitt’s Center for Behavioral Health and Smart Technology.

For the study, researchers enrolled 329 patients, aged 18 to 64 years, who had been referred by their primary care physicians at six practice locations affiliated with the University of Pittsburgh Medical Center (UPMC).

Approximately 250 patients were categorized as “highly anxious” and randomly assigned to either the telephone-delivered intervention or to their primary care physician’s usual care. The other 79 patients with “moderate” levels of anxiety symptoms were assigned to a “watchful waiting” group and later randomized if their anxiety symptoms became worse.

A study care manager regularly called patients in the phone-care group to provide the following: basic psychoeducation, encourage healthy habits (sleep, exercise, avoid excess alcohol), assess treatment preferences for anti-anxiety medications, monitor response to treatment, and inform their primary care physicians of their care preference and progress.

At the 12-month follow-up assessment, researchers found that anxiety symptoms remitted in 53 percent of intervention patients versus only 32 percent of the patients who continued to receive their primary care physicians’ usual care. The phone intervention also resulted in similar significant improvements in health-related quality of life, panic, and mood symptoms.

Significantly, these benefits remained for a year after the intervention had ended. African-Americans and men reported the highest levels of improvement, and the 79 patients who reported moderate levels of anxiety at baseline generally did well over the course of follow-up, whether they were later randomized to the study intervention or not.

“Effective collaborative care for anxiety can be provided via telephone by college-educated, non-mental health care managers who follow an evidence-based treatment algorithm and work under the direction of a primary care physician,” said Rollman.

The findings are published in the March issue of the Journal of General Internal Medicine.

Source: University of Pittsburgh Schools of the Health Sciences