JAMA published “Treating Anxiety 2017: Optimizing Care to Improve Outcomes” on July 18, 2017. This article provided information to primary care physicians about how to manage anxiety in their office settings, and some of the information provided potentially supports coordination of care between PCPs and behavioral clinicians. A portion of the article is available for free online, but accessing the entire article requires either a subscription to JAMA or paying a user fee, and MHConcierge was glad to pay the fee in order to be able to report to loyal readers about the entire article.

The article begins by noting the prevalence of anxiety disorders among US adults, which is estimated to be 10% during a 12-month period. The article also notes that no new anxiolytic medications have been approved by the FDA since 2007.  The article discusses recommendations for optimizing treatment of anxiety based PCPs using current resources, including both medications and psychosocial therapies.

The article provides best practices recommendations. For starters, given that features of anxiety disorders can because by medical conditions, a physical examination is recommended for patients with new-onset anxiety. Tip #1: this supports the best practices recommendation for behavioral clinicians to refer new patients with anxiety symptoms to the patient’s PCP for a screening of possible medical conditions, and to coordinate care.  You could use this info to market your practice to local PCPs. 

The article supports use measures of anxiety symptoms to track severity and treatment response. This could include both simple symptom rating scales and more “broadband” outcomes measurement scales. Tip #2: This could potentially support referral by PCPs to behavioral clinicians, who can provide more frequent appointments and symptom monitoring than can be provided by the typical PCP. You could use this info for, again, marketing to PCPs. 

Of particular interest to MHConcierge, another best practice recommendation is “stepped care,” which begins with interventions that are “accessible, low-cost, and safe.” The authors recommend “prescribing” physical exercise and mindfulness-based stress reduction approaches, although the authors recommended that PCPs “refer” to online resources or apps. They also mentioned, but just in passing, the potential benefits of yoga and meditation.  Tip #3: Obviously, this could support referral to behavioral clinicians for adjunctive therapy that includes use of these behavioral change to help with anxiety symptoms. Once again- a potential marketing opportunity. 

Of course, a best practice recommended for PCPs is, if the initial behavioral interventions to not prove to be adequate, medication. The article notes,”Many patients will discontinue medication at the first sign of an adverse drug effect.” Tip #4: Once again, this could support collaboration between behavioral clinicians and PCPs to help patients manage any side effects that are distressing to them, and this info can be used to encourage PCPs to refer. 

Finally, the article briefly, but matter-of-factly, recommends referral for adjunctive CBT,  noting, “the evidence for CBT for anxiety has increased.”  Tip #5: Obviously, this supports the potential benefits of behavioral clinicians partnering with PCPs to offer their CBT skills, in addition to the other potential collaborative benefits. 


MHConcierge’s take: this article provides considerable support for the potential benefits of collaboration between PCPs and behavioral clinicians to help patients with anxiety. Unfortunately, the article only implies some potential opportunities for behavioral clinicians to collaborate with PCPs, and it will likely be necessary for behavioral clinicians to reach out to PCPs, to make them aware of how people clinicians can help them manage their patients with anxiety, and to demonstrate their competence with have the opportunity to do this.

Here are our main tips:

1. Create a marketing letter that briefly summarizes what you can do to help PCPs manage their patients with anxiety, including a summary of recent research and how you would collaborate with them (outcomes measures, period treatment updates, monitoring medication compliance, help with behavioral changes).

2. The best opportunity for this most likely will occur when a  behavioral clinicians starts treating a patient with new-onset anxiety, and reaches out to collaborate with the PCP and provides ongoing coordination of care updates.

The partial JAMA article is available for free online, and access to the full articles available for 24 hours costs $30.

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