7029
document
A randomized effectiveness trial of collaborative care for patients with panic disorder in primary care . 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 .
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Intervention_Other
collaborative care
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Intervention_Pharmacological
PD pharmacotherapy
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Intervention_Educational
CC
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Intervention_Educational
educational videotapes and pamphlets
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Intervention_Pharmacological
pharmacotherapy with the selective serotonin reuptake inhibitor paroxetine
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Outcome_Other
effectiveness
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Outcome_Other
Effectiveness
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Outcome_Other
clinical effectiveness
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Outcome_Mental
panic
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Outcome_Mental
anxiety sensitivity
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Outcome_Mental
depression
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Outcome_Mental
disability variables
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Outcome_Other
Adequacy of pharmacotherapy
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Outcome_Other
algorithm
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Outcome_Mental
adhere to this medication
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Outcome_Mental
improved
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Outcome_Mental
anxiety
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Outcome_Mental
depression
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Outcome_Mental
disability measures
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Outcome_Mental
intensity
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Participant_Condition
panic disorder
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Participant_Sample-size
One hundred fifteen
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Participant_Condition
PD
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Participant_Condition
PD