title: Shifts in the care for patients presenting in primary care with anxiety; stepped collaborative care parameters from more than a decade.
abstract: BACKGROUND
  The mental health burden on primary care is substantial and increasing. Anxiety is a major contributor. Stepped collaborative care (SCC) is implemented worldwide to improve patient outcomes, but long term real-world evaluations of SCC do not exist. Using routinely used electronic medical records from more than a decade, we investigated changes in anxiety prevalences, whether physicians made distinction between non-severe and severe anxiety, and whether these groups were referred and treated differently, both non-pharmacologically and pharmacologically.
  
  
  METHODS
  Retrospective assessment of anxiety care parameters recorded by 54 general practitioners between 2003 and 2014, in the electronic medical records of a dynamic population of 49,841-69,413 primary care patients.
  
  
  RESULTS
  Substantial shifts in anxiety care parameters have occurred. The prevalence of anxiety symptoms doubled to 0.9% and of anxiety disorders almost tripled to 1.1%. Use of ICPC codes seemed comprehensive and use of instruments to support in anxiety level differentiation increased to 13% of anxiety symptom and 7% of anxiety disorder patients in 2014. Minimal interventions were used more frequently, especially for anxiety symptoms (OR 21 [95% CI 5.1-85]). The antidepressant prescription rates decreased significantly for anxiety symptoms (OR 0.5 [95% CI 0.4-0.8]) and anxiety disorders (OR 0.6 [95% CI 0.4-0.8]). More patients were referred to psychologists and psychiatrists.
  
  
  CONCLUSIONS
  We found shifts in anxiety care parameters that follow the principles of SCC. Future primary care research should comprehensively assess the use of the SCC range of therapeutic options, tailored to patients with all different anxiety severity levels.
authors.affiliation: Department of Family Medicine, Maastricht University/CAPHRI School for Public Health and Primary Care, P. Debyeplein 1, 6229 HA, Maastricht, P.O. Box 616, 6200 MD Maastricht, The Netherlands. Electronic address: Luc.Gidding@maastrichtuniversity.nl.
authors.forename: L G
authors.initials: LG
authors.lastname: Gidding
authors.affiliation: Department of Family Medicine, Maastricht University/CAPHRI School for Public Health and Primary Care, P. Debyeplein 1, 6229 HA, Maastricht, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
authors.forename: M G
authors.initials: MG
authors.lastname: Spigt
authors.affiliation: Department of Family Medicine, Maastricht University/CAPHRI School for Public Health and Primary Care, P. Debyeplein 1, 6229 HA, Maastricht, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
authors.forename: J G
authors.initials: JG
authors.lastname: Maris
authors.affiliation: The Eindhoven Corporation of primary health care centres, Pastoriestraat 161, 5612 EK Eindhoven, P.O. Box 8736, 5605 LS Eindhoven, The Netherlands.
authors.forename: O
authors.initials: O
authors.lastname: Herijgers
authors.affiliation: Department of Family Medicine, Maastricht University/CAPHRI School for Public Health and Primary Care, P. Debyeplein 1, 6229 HA, Maastricht, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
authors.forename: G-J
authors.initials: GJ
authors.lastname: Dinant
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D011320:Primary Health Care / Q000379:methods*; D011580:Psychological Techniques; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D012017:Referral and Consultation; D012189:Retrospective Studies
chemical_list: D011619:Psychotropic Drugs
keywords: Anxiety disorders; Disease management; Electronic medical records; Primary health care; Stepped collaborative care