title: What determines the management of anxiety disorders and its improvement?
abstract: BACKGROUND
  Although anxiety disorders are highly prevalent, lack of correct diagnosis and related concerns about treatment are serious clinical problems. Several factors affect, positively or negatively, management of anxiety and its improvement. A literature review and thematic analysis was executed to obtain an overview of the types of determinants of anxiety care and its improvement.
  
  
  METHODS
  Literature was identified from electronic database searching (January 1995-March 2006), contact with authors of studies, and searching of websites of organizations concerned with mental health. By using a template analysis approach, a set of strong themes relating to determinants of anxiety care and its improvement was identified.
  
  
  RESULTS
  The 15 eligible studies identified 43 factors that impeded or facilitated optimal anxiety care and its improvement. Individual characteristics of both patients (n = 13) and professionals (n = 6) were most frequently reported as determinants of anxiety care and its improvement. A considerable number of factors were related to the organizational context (n = 12), such as practice type and location. Some factors related to the social context (n = 4), the economic context (n = 2), or to the innovation itself (n = 6) were identified.
  
  
  CONCLUSIONS
  The findings show that there is a multitude of barriers and facilitators to optimal anxiety care and its improvement. Some determinants are modifiable, and thus responsive to interventions. Examples are collaboration within and between organizations, financial resources and assignment of both an opinion leader and responsible staff. The quality of anxiety care can be improved by systematically designing innovation strategies which are tailored to a selection of the determinants identified in this study.
authors.affiliation: Centre for Quality of Care Research (WOK), Radboud University Nijmegen Medical Centre (RUNMC), Nijmegen, The Netherlands. m.smolders@kwazo.umcn.nl
authors.forename: Mirrian
authors.initials: M
authors.lastname: Smolders
authors.forename: Miranda
authors.initials: M
authors.lastname: Laurant
authors.forename: Anneke
authors.initials: A
authors.lastname: van Wamel
authors.forename: Richard
authors.initials: R
authors.lastname: Grol
authors.forename: Michel
authors.initials: M
authors.lastname: Wensing
mesh_terms: D001008:Anxiety Disorders / Q000175:diagnosis / Q000188:drug therapy; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D009426:Netherlands; D011787:Quality of Health Care