 |
|
A Randomized Effectiveness Trial of Collaborative Care for Patients With Panic Disorder in Primary Care
Peter P. Roy-Byrne, MD;
Wayne Katon, MD;
Deborah S. Cowley, MD;
Joan Russo, PhD
Arch Gen Psychiatry. 2001;58:869-876.
Background Effectiveness studies have tested interventions to improve quality of
care for depression in primary care, but none, to our knowledge, have been
completed for panic disorder (PD) in this setting. This study sought to test
the clinical effectiveness of PD pharmacotherapy embedded in a disease management
framework of "collaborative care" (CC).
Methods One hundred fifteen patients with PD from 3 primary care clinics were
randomized to CC or "usual care" (UC). Patients in CC (n = 57) received educational
videotapes and pamphlets; pharmacotherapy with the selective serotonin reuptake
inhibitor paroxetine; 2 psychiatrist visits and 2 telephone calls in the first
8 weeks; and up to 5 telephone calls between 3 and 12 months' follow-up. Usual
care patients (n = 58) were treated by their primary care physician. Telephone
assessments of panic, anxiety sensitivity, depression, and disability variables
were performed at 3, 6, 9, and 12 months' follow-up. Adequacy of pharmacotherapy
was assessed with an algorithm based on a review of efficacy studies.
Results Patients in CC were more likely to receive adequate (type, dose, duration)
medication and more likely to adhere to this medication at 3 and 6 months.
Random regression analyses showed that CC patients improved significantly
more over time compared with UC patients on anxiety, depression, and disability
measures, with the greatest effects at 3 and 6 months.
Conclusions Compared with UC, CC interventions significantly improved both quality
of care and clinical and functional outcomes in primary care PD patients.
Clinical differences were greatest in the first 6 months, corresponding to
the greater quality of care and the greater intensity of intervention.
From the Department of Psychiatry and Behavioral Sciences, University
of Washington School of Medicine (Drs Roy-Byrne, Katon, Cowley, and Russo),
and Harborview Medical Center (Drs Roy-Byrne and Russo), Seattle.
Corresponding author and reprints: Peter P. Roy-Byrne, MD, Department
of Psychiatry and Behavioral Sciences, Harborview Medical Center, 325 9th
Ave, Box 359911, Seattle, WA 98104 (e-mail: roybyrne{at}u.washington.edu).
|
