Management of anxiety disorders in Australian primary care

Abstract

Anxiety disorders are highly prevalent mental health conditions that are managed predominantly in primary care. Primary care refers to community-based health care that serves as the first point of contact within a health care system. It may be delivered in a range of settings (e.g., general practice clinics, community health centres), and by a range of health professionals (e.g., general practitioners [GPs], psychologists). However, most care is provided in general practice by GPs, who may act as primary treating professionals or coordinators of specialist care, among other roles. Previous research suggests the real-world management of anxiety in primary care favours medication, which does not align with clinical practice guidelines that emphasise psychological interventions. In particular, high rates of benzodiazepines have been a concern, as these medications are no longer recommended for anxiety except in the short-term under specific conditions. Despite the high prevalence of anxiety disorders, their management in the Australian health care system is under-researched compared with other common conditions such as depression. The current research project therefore aimed to examine anxiety disorder management in Australian primary care settings. A mixed-methods approach was used to explore treatment outcomes, real-world management practices, and consumer perspectives. Firstly, a systematic review and meta-analysis was conducted to synthesise the evidence for treating anxiety in primary care. Findings demonstrated psychological treatments are effective in this setting, with larger effect sizes for treatment provided by a mental health specialist (e.g., clinical psychologist) than a non-specialist (e.g., general practitioner). Relatively few studies of primary care-specific pharmacological treatment were found. A second study described GP management of anxiety over 10 years through secondary analysis of a large, nationally representative study of GP activity. Consistent with previous research, medication was the most common strategy used to manage anxiety. However, trends over the period studied demonstrated an increase in referrals to psychologists and a decrease in the use of benzodiazepines. GP and patient characteristics also predicted the likelihood of different management strategies being used. High rates of management with benzodiazepines were found for certain groups despite the overall reduction in these medications. A third study involved an exploratory survey of consumers' experiences and priorities for treatment. Participants reported generally positive experiences of seeking help from a GP for anxiety. The majority of participants indicated effectiveness was the most important consideration for treatment, and considered 'how quickly the treatment works' to be less important. Suggestions to improve care for anxiety centred mainly on improving access and funding for psychologists, better training for GPs, and increasing community knowledge and awareness about anxiety. Overall, results from this research demonstrate the primary care management of anxiety is becoming more closely aligned with practice guidelines. However, integration of psychological treatments in primary care and high rates of benzodiazepine use for certain groups remains an issue in Australia. Exploratory research with consumers suggests improved provision of anxiety psychoeducation is also an area for improvement. Show more