Rationing of health care: clinical decision making in an outpatient clinic for anxiety disorders.
Anxiety disorders are prevalent and disabling and despite the fact that effective interventions are available, many people do not access effective treatment. Clinician decisions are fundamental determinants of access to this treatment. Despite this, treatment decisions have never been examined specifically in this group and are rarely examined in outpatient settings. The present study assessed 550 consecutive referrals to an anxiety disorders clinic in Sydney, Australia. Logistic regression was used to examine the predictors of decisions about treatment. Clinical patient variables (diagnosis and disability) were the strongest predictors of an offer of treatment but demographics and resource availability were also significant. Some of the same factors have been shown to influence the decision to seek treatment for anxiety. Both help-seeking behavior and treatment decision making are important determinants of access to care and both should be examined in future studies.
Issakidis
C
C
School of Psychiatry, University of New South Wales and the Clinical Research Unit for Anxiety Disorders, St Vincent's Hospital, Sydney, Australia. cathyi@crufad.unsw.edu.au
Andrews
G
G
D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D001008:Anxiety Disorders / Q000175:diagnosis / Q000628:therapy*; D001315:Australia; D002391:Catchment Area, Health; D003657:Decision Making; D003863:Depression / Q000175:diagnosis; D015276:Health Care Rationing / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006801:Humans; D016015:Logistic Models; D008485:Medical Audit; D008605:Mental Health Services / Q000600:supply & distribution*; D010342:Patient Acceptance of Health Care; D010554:Personality Disorders / Q000175:diagnosis; D010555:Personality Inventory; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012720:Severity of Illness Index