Quality of care for primary care patients with anxiety disorders
Quality of care for primary care patients with anxiety disorders
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DOI：
10.1176/appi.ajp.161.12.2230
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发表时间：
2004-12-01
影响因子：
17.7
通讯作者：
Roy-Byrne, PP
中科院分区：
文献类型：
--
作者：
Stein, MB;Sherbourne, CD;Roy-Byrne, PP
目的：本研究评估了洛杉矶、圣地亚哥和西雅图大学附属门诊诊所的焦虑症初级保健患者的护理质量。方法：对 366 名被诊断患有恐慌症、广泛性焦虑症、社交恐惧症和/或创伤后应激障碍（伴或不伴重度抑郁症）的初级保健门诊患者进行了调查，了解他们在过去 3 个月内接受的护理情况。质量指标包括过去 3 个月内的心理健康转诊、焦虑咨询和适当的抗焦虑药物的使用。结果：大约三分之一的焦虑症患者在过去 3 个月内接受过初级保健提供者的咨询。不到 10% 的人接受过心理健康专业人士的咨询，其中包括认知行为疗法的多种要素。大约 40% 的人在过去 3 个月内接受了适当的抗焦虑药物，但只有 25% 的人接受了最低足够的剂量和持续时间。总体而言，只有不到三分之一的患者接受了符合优质护理标准的心理治疗或药物治疗。在多变量分析中，患有抑郁症和/或内科疾病的患者更有可能接受适当的抗焦虑药物，而少数族裔患者则不太可能接受适当的抗焦虑药物。 结论：在大学附属初级保健实践中，焦虑症的优质护理率处于中等到低水平。尽管经常使用适当类型的药物治疗，但其持续时间往往不足。认知行为疗法明显未得到充分利用。这些发现强调需要制定初级保健中焦虑症的实践指南和实施质量改进计划。
Objective: This study evaluated quality of care for primary care patients with anxiety disorders in university-affiliated outpatient clinics in Los Angeles, San Diego, and Seattle.Method: Three hundred sixty-six primary care outpatients who were diagnosed with panic disorder, generalized anxiety disorder, social phobia, and/or posttraumatic stress disorder (with or without major depression) were surveyed about care received in the prior 3 months. Quality indicators were mental health referral, anxiety counseling, and use of appropriate antianxiety medication during the previous 3 months.Results: Approximately one-third of patients with anxiety disorders had received counseling from their primary care provider in the prior 3 months. Fewer than 10% had receiving counseling from a mental health professional that included multiple elements of cognitive behavior therapy. Approximately 40% had received appropriate antianxiety medications in the previous 3 months, although only 25% had received them at a minimally adequate dose and duration. Overall, fewer than one in three patients had received either psychotherapy or pharmacotherapy that met a criterion for quality care. In multivariate analyses, patients with comorbid depression and/or medical illness were more likely-and patients from ethnic minorities were less likely-to receive appropriate antianxiety medications.Conclusions: Rates of quality care for anxiety disorders are moderate to low in university-affiliated primary care practices. Although an appropriate type of pharmacotherapy was frequently used, it was often of inadequate duration. Cognitive behavior therapy was markedly underused. These findings emphasize the need for practice guidelines and implementation of quality improvement programs for anxiety disorders in primary care.