Generalized anxiety disorder in primary care: mental health services use and treatment adequacy

BMC Family Practice

Research Article

Louise Fournier¹  Pasquale Roberge²  François Normand-Lauzière²  Mireille Luc²  Isabelle Raymond²  Marie-Michèle Tanguay-Bernard²  Arnaud Duhoux³  Christian Bocti⁴ 

[1] CRCHUM (Centre de recherche du Centre Hospitalier de l’Université de Montréal), Université de Montréal, Pavillon Édouard-Asselin, 264, boul. René-Lévesque Est, H2X 1P1, Montréal, QC, Canada;Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001,12th Avenue North, J1H 5 N4, Sherbrooke, QC, Canada;Division of Neurology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001,12th Avenue North, J1H 5 N4, Sherbrooke, QC, Canada;Faculty of Nursing, Université de Montréal, Pavillon Marguerite-d’Youville, C.P. 6128 succ. Centre-ville, H3C 3 J7, Montreal, QC, Canada;

关键词: Generalized Anxiety Disorder;    Quality indicators;    Treatment Adequacy;    Primary Care;    Service Utilization;    Psychotherapy;    Pharmacotherapy;   

DOI  :  10.1186/s12875-015-0358-y

 received in 2015-08-12, accepted in 2015-10-06,  发布年份 2015

来源: Springer

【 摘 要 】

PurposeGeneralized Anxiety Disorder (GAD) is a common mental disorder in the primary care setting, marked by persistent anxiety and worries. The aims of this study were to: 1) examine mental health services utilisation in a large sample of primary care patients; 2) explore detection of GAD and minimal standards for pharmacological and psychological treatment adequacy based on recommendation from clinical practice guidelines; 3) examine correlates of treatment adequacy, i.e. predisposing, enabling and needs factors according to the Behavioural Model of Health Care Use.MethodsA sample of 373 adults meeting DSM-IV criteria for Generalized Anxiety Disorder in the past 12 months took part in this study. Data were drawn from the “Dialogue” project, a large primary care study conducted in 67 primary care clinics in Quebec, Canada. Following a mental health screening in medical clinics (n = 14833), patients at risk of anxiety or depression completed the Composite International Diagnostic Interview-Simplified (CIDIS). Multilevel logistic regression models were developed to examine correlates of treatment adequacy for pharmacological and psychological treatments.ResultsResults indicate that 52.5 % of participants were recognized as having GAD by a healthcare professional in the past 12 months, and 36.2 % of the sample received a pharmacological (24.4 %) and/or psychological treatment (19.2 %) meeting indicators based on clinical practice guidelines recommendations. The detection of GAD by a health professional and the presence of comorbid depression were associated with overall treatment adequacy.ConclusionsThis study suggests that further efforts towards GAD detection could lead to an increase in the delivery of evidence-based treatments. Key targets for improvement in treatment adequacy include regular follow up of patients with a GAD medication and access to psychotherapy from the primary care setting.

【 授权许可】

CC BY   
© Roberge et al. 2015