BACKGROUND:Collaborative stepped care (CSC) may be an appropriate model to provide evidence-based treatment for anxiety disorders in primary care. METHODS: In a cluster randomised controlled trial, the effectiveness of CSC compared to care as usual (CAU) for adults with panic disorder (PD) orgeneralised anxiety disorder (GAD) in primary care was evaluated. Thirty-one psychiatric nurses who provided their services to 43 primary care practices in the Netherlands were randomised to deliver CSC (16 psychiatric nurses, 23 practices) or CAU (15 psychiatric nurses, 20 practices). CSC was provided by the psychiatric nurses (care managers) in collaboration with the general practitioner and a consultant psychiatrist. The intervention consisted of 3 steps, namely guided self-help, cognitive behavioural therapy and antidepressants. Anxiety symptoms were measured with the Beck Anxiety Inventory (BAI) at baseline and after 3, 6, 9 and 12 months. RESULTS: We recruited 180 patients with a DSM-IV diagnosis of PD or GAD, of whom 114 received CSC and 66 received usual primary care. On the BAI, CSC was superior to CAU [difference in gain scores from baseline to 3 months: -5.11, 95% confidence interval (CI) -8.28 to -1.94; 6 months: -4.65, 95% CI -7.93 to -1.38; 9 months: -5.67, 95% CI -8.97 to -2.36; 12 months: -6.84, 95% CI -10.13 to -3.55]. CONCLUSIONS:CSC, with guided self-help as a first step, was more effective than CAU for primary care patients with PD or GAD.
RCT Entities:
BACKGROUND: Collaborative stepped care (CSC) may be an appropriate model to provide evidence-based treatment for anxiety disorders in primary care. METHODS: In a cluster randomised controlled trial, the effectiveness of CSC compared to care as usual (CAU) for adults with panic disorder (PD) or generalised anxiety disorder (GAD) in primary care was evaluated. Thirty-one psychiatric nurses who provided their services to 43 primary care practices in the Netherlands were randomised to deliver CSC (16 psychiatric nurses, 23 practices) or CAU (15 psychiatric nurses, 20 practices). CSC was provided by the psychiatric nurses (care managers) in collaboration with the general practitioner and a consultant psychiatrist. The intervention consisted of 3 steps, namely guided self-help, cognitive behavioural therapy and antidepressants. Anxiety symptoms were measured with the Beck Anxiety Inventory (BAI) at baseline and after 3, 6, 9 and 12 months. RESULTS: We recruited 180 patients with a DSM-IV diagnosis of PD or GAD, of whom 114 received CSC and 66 received usual primary care. On the BAI, CSC was superior to CAU [difference in gain scores from baseline to 3 months: -5.11, 95% confidence interval (CI) -8.28 to -1.94; 6 months: -4.65, 95% CI -7.93 to -1.38; 9 months: -5.67, 95% CI -8.97 to -2.36; 12 months: -6.84, 95% CI -10.13 to -3.55]. CONCLUSIONS: CSC, with guided self-help as a first step, was more effective than CAU for primary care patients with PD or GAD.
Authors: Iman Elfeddali; Christina M van der Feltz-Cornelis; Jim van Os; Susanne Knappe; Eduard Vieta; Hans-Ulrich Wittchen; Carla Obradors-Tarragó; Josep Maria Haro Journal: Int J Environ Res Public Health Date: 2014-10-21 Impact factor: 3.390
Authors: Anna Dt Muntingh; Christina M van der Feltz-Cornelis; Harm Wj van Marwijk; Philip Spinhoven; Anton Jlm van Balkom Journal: BMC Fam Pract Date: 2016-06-02 Impact factor: 2.497
Authors: Geke Romijn; Heleen Riper; Robin Kok; Tara Donker; Maartje Goorden; Leona Hakkaart van Roijen; Lisa Kooistra; Anton van Balkom; Jeroen Koning Journal: BMC Psychiatry Date: 2015-12-12 Impact factor: 3.630