Necessary but not sufficient

Objective: To consider the impact on primary care patient outcomes of using both a screener to determine elevated anxiety levels among patients with previously undetected anxiety and a physician intervention to inform physicians of their patients’ conditions. Design: Participating physicians were randomized to either the demonstration or the control arm, and patients were assigned to a study arm based on the randomization of their physicians. The patients were followed for change in outcome measures during the five-month study period. Setting: A mixed-model health maintenance organization serving approximately 110,000 enrollees in central Colorado. Patients/participants: 573 patients who had unrecognized and untreated anxiety identified from the approximately 8,000 patients who completed the waiting room screening questionnaire. Interventions: A physician intervention served the dual function of 1) providing an educational demonstration of anxiety in the primary care setting and 2) providing a reporting system for summarizing the anxiety symptom levels and functioning status of the patients enrolled in the study. Measurements and main results: Patient outcomes were measured as changes in global anxiety scores, functioning and well-being, and patients’ reports of global improvements. Conclusions: The findings indicate that this method of reporting symptoms and functioning status to primary care physicians did not significantly change patient outcomes. Improvement in outcomes appeared to be more closely associated with the patient’s severity of psychological distress. Preliminary data from this study were presented at the Seventh Annual National Institute of Mental Health International Research Conference on Mental Health Problems in the General Health Care Sector, September 20–22, 1993, McLean, Virginia, and at the first Annual Symposium of Contributed Papers on Quality of Life at the Drug Information Association Workshop, April 26–27, 1993, Charleston, South Carolina. Supported by a grant from the Upjohn Company, Kalamazoo, Michigan, and Take Care, Colorado. (Note: Dr. Buesching is a former employee of the Upjohn Company but owns no stock or option to purchase further stock in the company. Ms. Mathias, Dr. Fifer, Dr. Mazonson, Dr. Lubeck, and Dr. Patrick own no stock or option in the Upjohn Company.)