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Telephone-delivered collaborative care improves anxiety

A collaborative care intervention delivered over the phone reduced anxiety and improve quality of life and mood among adults with anxiety.

“While dozens of clinical trials have demonstrated the effectiveness of collaborative care for treating depression in primary care, comparatively few have addressed anxiety, despite their similar prevalence and adverse impact on health-related quality of life and excess utilization of health services,” said Bruce L. Rollman, MD, MPH, of University of Pittsburgh School of Medicine, said in a press release. “Effective collaborative care for anxiety can be provided via telephone by college-educated, non-mental health care managers who follow an evidence-based treatment algorithm and work under the direction of a primary care physician.”

Bruce L. Rollman

To assess the impact and durability of a centralized, telephone-delivered stepped collaborative care intervention for anxiety disorders among primary care practices, researchers conducted a randomized controlled trial including 329 adults. Study participants were highly anxious (n = 250) or moderately anxious (n = 79) and were randomly assigned to receive collaborative care or usual care for 12 months. Collaborative care consisted of non-mental health professionals providing participants with basic psychoeducation, assessing preferences for pharmacotherapy, monitoring treatment responses and informing primary care physicians (PCPs) of patients’ care preferences and progress via electric medical records (EMR).

At 12-month follow-up, participants with high anxiety reported improved mental health-related quality of life (P = .003), anxiety (P = .02) and mood (P = .001), compared with usual care.

These improvements continued for 12 months among blacks and men.

Participants with moderate anxiety reported fewer anxiety and mood symptoms and better mental health-related quality of life during 24 months of follow-up, compared with participants with high anxiety.

“A telephone-delivered, centralized collaborative care intervention provided by non-mental health professionals to highly anxious patients referred by their PCP in response to an EMR-generated prompt led to significantly improved mental [health-related quality of life], anxiety, and mood symptoms compared to PCPs’ usual care,” the researchers wrote. “These improvements were durable for up to 12 months, and were particularly evident among African-Americans. Future collaborative care trials should evaluate the effectiveness of replacing self-management workbooks with Internet-delivered [computerized cognitive behavioral therapy] programs that have the potential to deliver more effective behavioral health treatment at scale.” – by Amanda Oldt

Disclosure: Rollman reports no relevant financial disclosures. Please see the study for a full list of relevant financial disclosures.