Patients with panic disorder who received collaborative care, rather than usual primary care, had on the average over 74 more anxiety-free days over the following year, according to an article in this week’s Archives of General Psychiatry. Collaborative care included enhanced patient education and about two psychiatric visits integrated into primary care. The psychiatric visits were aimed at helping the primary care physician provide optimal pharmacologic treatment of panic disorder. Cost-effectiveness analysis showed a 70 percent probability that this collaborative care was associated with decreased outpatient medical costs and was more effective in reducing panic symptoms.
Dr. Wayne Katon, director of the Division of Health Services and Psychiatric Epidemiology at the University of Washington School of Medicine, was the article’s lead author. He said that he and Dr. Peter Roy-Byrne, professor of psychiatry and behavioral sciences, integrated a psychiatrist into three primary care clinics in the Seattle area in order to help primary care physicians with pharmacologic management for these patients.
“The usual primary care for patients with panic disorder or major depression is associated with improved outcomes in about 40 percent of patients,” Katon said. “Seventy to 75 percent of the patients who participated in the collaborative care program showed improved outcomes. They also had many more days that they themselves rated as anxiety-free over the following year — about 74, compared to patients who had typical primary care for their symptoms.”
Additionally, patients given collaborative care were more likely to take anti-panic medication as prescribed. Collaborative care was also associated with improved symptomatic and functional outcomes for these patients, compared to the control group, which received the usual care provided to patients with panic disorder in primary care clinics.
Patients receiving collaborative care reported about 230 anxiety-free days over the subsequent 12 month period, while patients receiving usual primary care for anxiety reported about 150 anxiety-free days over the same period. Statistical adjustments resulted in the 74 -day figure.