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BMC Health Services Research
Published in: BMC Health Services Research 1/2009

Open Access 01-12-2009 | Study protocol

Collaborative stepped care for anxiety disorders in primary care: aims and design of a randomized controlled trial

Authors: Anna DT Muntingh, Christina M van der Feltz-Cornelis, Harm WJ van Marwijk, Philip Spinhoven, Willem JJ Assendelft, Margot WM de Waal, Leona Hakkaart-van Roijen, Herman J Adèr, Anton JLM van Balkom

Published in: BMC Health Services Research | Issue 1/2009

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Abstract

Background

Panic disorder (PD) and generalized anxiety disorder (GAD) are two of the most disabling and costly anxiety disorders seen in primary care. However, treatment quality of these disorders in primary care generally falls beneath the standard of international guidelines. Collaborative stepped care is recommended for improving treatment of anxiety disorders, but cost-effectiveness of such an intervention has not yet been assessed in primary care. This article describes the aims and design of a study that is currently underway. The aim of this study is to evaluate effects and costs of a collaborative stepped care approach in the primary care setting for patients with PD and GAD compared with care as usual.

Methods/design

The study is a two armed, cluster randomized controlled trial. Care managers and their primary care practices will be randomized to deliver either collaborative stepped care (CSC) or care as usual (CAU). In the CSC group a general practitioner, care manager and psychiatrist work together in a collaborative care framework. Stepped care is provided in three steps: 1) guided self-help, 2) cognitive behavioral therapy and 3) antidepressant medication. Primary care patients with a DSM-IV diagnosis of PD and/or GAD will be included. 134 completers are needed to attain sufficient power to show a clinically significant effect of 1/2 SD on the primary outcome measure, the Beck Anxiety Inventory (BAI). Data on anxiety symptoms, mental and physical health, quality of life, health resource use and productivity will be collected at baseline and after three, six, nine and twelve months.

Discussion

It is hypothesized that the collaborative stepped care intervention will be more cost-effective than care as usual. The pragmatic design of this study will enable the researchers to evaluate what is possible in real clinical practice, rather than under ideal circumstances. Many requirements for a high quality trial are being met. Results of this study will contribute to treatment options for GAD and PD in the primary care setting. Results will become available in 2011.

Trial registration

NTR1071
Appendix
Available only for authorised users
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Metadata
Title
Collaborative stepped care for anxiety disorders in primary care: aims and design of a randomized controlled trial
Authors
Anna DT Muntingh
Christina M van der Feltz-Cornelis
Harm WJ van Marwijk
Philip Spinhoven
Willem JJ Assendelft
Margot WM de Waal
Leona Hakkaart-van Roijen
Herman J Adèr
Anton JLM van Balkom
Publication date
01-12-2009
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2009
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-9-159

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