title: A contemporary protocol to assist primary care physicians in the treatment of panic and generalized anxiety disorders.
abstract: Anxiety disorders are prevalent in primary care practice and generate a significant excess of morbidity, health services utilization, and health care expenditures. Complexities in delivering effective care for such disorders have led to stepped collaborative care models that involve nonphysician care managers following guideline-based protocols under the direction of patients' primary care physicians and a medical specialist. With the goal of aiding colleagues attempting to improve the primary care for panic and generalized anxiety disorders, we detail the collaborative care strategy for treatment of these conditions used by our National Institute of Mental Health (NIMH)-funded clinical trial in which a telephone-based care manager performs timely, patient-specific clinical and case management tasks. We illustrate the clinical considerations underlying the steps taken to implement and then sustain our care manager intervention at four geographically dispersed primary care practices linked by a common electronic medical record system and the modifications made as we encountered clinical situations common to typical practice settings. This report serves to familiarize physicians contemplating use of a similar strategy for improving the quality of primary care for an anxiety disorder or any other chronic mental health condition.
authors.affiliation: Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, PA, USA. rollmanbl@msx.upmc.edu
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Rollman
authors.forename: Bea
authors.initials: B
authors.lastname: Herbeck Belnap
authors.forename: Charles F
authors.initials: CF
authors.lastname: Reynolds
authors.forename: Herbert C
authors.initials: HC
authors.lastname: Schulberg
authors.forename: M Katherine
authors.initials: MK
authors.lastname: Shear
mesh_terms: D000465:Algorithms; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000628:therapy*; D002908:Chronic Disease; D002985:Clinical Protocols; D017408:Guidelines as Topic; D006801:Humans; D008605:Mental Health Services / Q000706:statistics & numerical data; D016584:Panic Disorder / Q000628:therapy*; D010346:Patient Care Management; D010348:Patient Care Team; D010353:Patient Education as Topic; D010820:Physicians; D011320:Primary Health Care
chemical_list: D014151:Anti-Anxiety Agents