Every so often I rework a popular article from the archives. A year ago I ran a piece on poor treatment and outcomes for anxiety disorder sufferers who relied upon primary care-based mental health care. Let’s take another look.
I enjoyed an editorial that appeared in the March 6, 2007 edition of the Annals of Internal Medicine. It was written by the University of Washington’s Wayne Katon, M.D. and Peter Roy-Byrne, M.D.
The editorial began with Drs. Katon and Roy-Byrne referring to the anxiety disorders as the neglected stepchild of primary care-based mental health care.
It’s of no surprise those enduring anxiety disorders frequently turn to their primary care physician for assistance. In addition to familiarity and security, the physical manifestations of the anxiety disorders have much to do with why we end-up on our PCPs front doorstep.
I mean, we may experience chest pain, rapid heart rate, heart palpitations, breathing difficulty, gastrointestinal issues, and on and on.
Drs. Katon and Roy-Byrne cited the research of Kurt Kroenke, M.D., of Indiana University and the Regenstrief Institute. Kroenke’s work tells us generalized anxiety disorder, panic disorder, social anxiety disorder (social phobia), and posttraumatic stress disorder are the most frequently presenting anxiety disorders at a primary care practice.
Kroenke’s research goes on to report there are several brief and reliable screening questionnaires that address all four of the disorders just mentioned, most notably the GAD-2 and GAD-7.
By the way, his work reveals that more than 40% of studied patients presenting with an anxiety disorder stated they weren’t receiving any mental health treatment whatsoever.
Obviously, an accurate diagnosis is key to treatment planning and a positive outcome. But Katon and Roy-Byrne reported studies indicate that even when an accurate diagnosis has been established, there are still significant gaps in care through the primary care practice.
Among these are poor physician follow-up, which often leads to meds non-compliance, and very limited exposure to efficacious psychotherapies.
So, when you pull together the data, primary care-based mental health care just doesn’t appear to be an option for those enduring anxiety disorders.
Drs. Katon and Roy-Byrne believe it’s time for major change and suggest looking at primary care-based depression screening protocols as a starting point. They go on to recommend greater emphasis upon anxiety screening and linking screened anxiety sufferers with proven treatment resources.
And they propose the use of allied health professionals in supporting the work of the primary care physician. Imagine a qualified professional who provides anxiety education to patients and staff. And this same team member could monitor treatment compliance and outcomes, facilitating physician follow-up appointments should the patient’s circumstances not improve.
This allied professional could even work with a psychiatrist on medication adjustments and recommendations, passing the information on to the physician.
Very revealing information, don’t you think? But as distressing as much of it is, there’s every reason in the world to be hopeful. And that’s because studies show the recommendations of change suggested by Drs. Katon and Roy-Byrne work. Period. So, it’s time to identify barriers to correction and push them aside.
There’s absolutely no reason why someone enduring an anxiety disorder shouldn’t be able to see his/her primary care physician and benefit from a great initial, and ongoing, collaborative offensive against their nemesis.
Anything less is simply an injustice and a very sad missed opportunity.
What do you say, chipur readers – any choice experiences with a primary care physician or practice you’d like to share? You can do so in a comment.
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