A new treatment model for anxiety in primary care

January 01, 0001

A new treatment model for anxiety in primary care

Anxiety is a common disorder seen and treated in primary care. These US researchers examined the use of a flexible treatment-delivery model for multiple primary care anxiety disorders named Coordinated Anxiety Learning and Management (CALM) compared versus usual care (UC). The CALM model allowed choice of cognitive behavioral therapy (CBT), medication, or both, involved real-time Web-based outcomes monitoring a computer-assisted program to optimize delivery of CBT by nonexpert care managers who also assisted primary care clinicians in promoting adherence and optimizing medications. The researchers performed a randomized controlled trial in 17 primary care clinics in 4 US cities, enrolling 1004 participants. Patients received treatment for 3-12 months, and had blinded follow up at 6, 12, and 18 months.

The researchers found: "A significantly greater improvement for CALM vs UC in global anxiety symptoms was found (BSI-12 group mean differences of -2.49, -2.63, and -1.63 at 6, 12, and 18 months, respectively). At 12 months, response and remission rates CALM vs UC) were 63.66% vs 44.68%, and 51.49% vs 33.28%, with a number needed to treat of 5.27 for response and 5.50 for remission."

The researchers concluded: "For patients with anxiety disorders treated in primary care clinics, CALM compared with UC resulted in greater improvement in anxiety symptoms, depression symptoms, functional disability, and quality of care during 18 months of follow-up."

This study finds the CALM model to be more effective that usual care in treating patients with anxiety, and had very favorable numbers needed to treat, although cost-effectiveness issue remain to be elucidated.

For the full abstract, click here.

JAMA 303(19):1921-1928,19 May 2010 © 2010 American Medical Association
Delivery of Evidence-Based Treatment for Multiple Anxiety Disorders in Primary Care: A Randomized Controlled Trial. Peter Roy-Byrne, Michelle G. Craske, Greer Sullivan, et al.

Category: P. Psychological. Keywords: Coordinated Anxiety Learning and Management, CALM, anxiety, treatment, cognitive behavioral therapy, CBT, primary care, randomized controlled trial, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 18 June 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.