Interventions to improve management of anxiety disorders in general practice: a systematic review.
BACKGROUND
Anxiety disorders are common in general practice and are associated with several problems regarding recognition and management.


OBJECTIVE
To systematically evaluate the effectiveness of interventions aimed at improving recognition, diagnosis, and management of patients with anxiety disorders.


METHODS
Systematic review.


METHODS
MEDLINE, EMBASE, PsychINFO, and the Cochrane Clinical Trials' Register were searched up until 2003. Randomised controlled trials, controlled before/after trials, and interrupted time series for professional, organisational, financial, and regulatory interventions were eligible. Primary effect measures consisted of anxiety outcomes, diagnosis, prescription, and referral. Two reviewers independently made eligibility judgments: eight out of 563 articles were found to be eligible. Two reviewers participated independently in the quality assessment and data extraction process using a standardised form based on the Effective Practice and Organisation of Care checklist. Relative risks or standardised mean differences were calculated when possible.


RESULTS
Four professional interventions and three organisational interventions were examined. In general, the professional interventions seemed to increase recognition, referral, and prescription as well as improving anxiety outcomes. Two out of three organisational interventions showed a positive effect on anxiety outcomes. The one study that took prescription into account showed no effect.


CONCLUSIONS
The quality of care for patients with anxiety can be improved. A combination of professional and organisational interventions in which an external expert is introduced seems to be most promising. Additional research is nevertheless necessary to determine the exact effects of such interventions using patient effect measures, economic evaluations, and feasibility studies.
Heideman
Jantien
J
Centre for Quality of Care Research (WOK) University Medical Centre Nijmegen, The Netherlands. j.heideman@wok.umcn.nl
van Rijswijk
Eric
E
van Lin
Nieke
N
de Loos
Sandra
S
Laurant
Miranda
M
Wensing
Michel
M
van de Lisdonk
Eloy
E
Grol
Richard
R
D001008:Anxiety Disorders / Q000175:diagnosis / Q000628:therapy*; D005194:Family Practice; D006801:Humans; D015397:Program Evaluation; D011569:Psychiatric Status Rating Scales; D011787:Quality of Health Care