title: Adequacy of treatment received by primary care patients with anxiety disorders.
abstract: BACKGROUND
  We examined the adequacy of pharmacotherapy and psychotherapy received by primary care patients with anxiety disorders over up to 5 years of follow-up.
  
  
  METHODS
  Five hundred thirty-four primary care patients at 15 US sites, who screened positive for anxiety symptoms, were assessed for anxiety disorders. Those meeting anxiety disorder criteria were offered participation and interviewed again at six and 12 months postintake, and yearly thereafter for up to 5 years. We utilized existing definitions of appropriate pharmacotherapy and created definitions of potentially adequate psychotherapy/cognitive-behavioral therapy (CBT).
  
  
  RESULTS
  At intake, of 534 primary care participants with anxiety disorders, 19% reported receiving appropriate pharmacotherapy and 14% potentially adequate CBT. Overall, 28% of participants reported receiving potentially adequate anxiety treatment, whether pharmacotherapy, psychotherapy, or both. Over up to five years of follow-up, appropriate pharmacotherapy was received by 60% and potentially adequate CBT by 36% of the sample. Examined together, 69% of participants received any potentially adequate treatment during the follow-up period. Over the course of follow-up, primary care patients with MDD, panic disorder with agoraphobia, and with medicaid/medicare were more likely to receive appropriate anxiety treatment. Ethnic minority members were less likely to receive potentially adequate care.
  
  
  CONCLUSIONS
  Potentially adequate anxiety treatment was rarely received by primary care patients with anxiety disorders at intake. Encouragingly, rates improved over the course of the study. However, potentially adequate CBT remained much less utilized than pharmacotherapy and racial-ethnic minority members were less likely to received care, suggesting much room for improved dissemination of quality treatment.
authors.affiliation: Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island; Department of Family Medicine, Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Risa B
authors.initials: RB
authors.lastname: Weisberg
authors.forename: Courtney
authors.initials: C
authors.lastname: Beard
authors.forename: Ethan
authors.initials: E
authors.lastname: Moitra
authors.forename: Ingrid
authors.initials: I
authors.lastname: Dyck
authors.forename: Martin B
authors.initials: MB
authors.lastname: Keller
mesh_terms: D000328:Adult; D000379:Agoraphobia / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D014151:Anti-Anxiety Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D001291:Attitude of Health Personnel; D015928:Cognitive Behavioral Therapy; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009511:New England; D017060:Patient Satisfaction; D011320:Primary Health Care; D011613:Psychotherapy; D011795:Surveys and Questionnaires
chemical_list: D014151:Anti-Anxiety Agents
keywords: PTSD/posttraumatic stress disorder; anxiety disorders; cognitive behavioral therapy; dissemination/implementation; generalized anxiety disorder; panic disorder/agoraphobia; pharmacotherapy; primary healthcare; social phobia/social anxiety disorder