Access to psychotherapy for primary care patients with anxiety disorders.

Abstract

Anxiety disorders are common mental health problems in the community, and primary care has a predominant role in the diagnosis and treatment of these conditions. While most patients are treated with pharmacotherapy, clinical practice guidelines recommendations also comprise psychotherapy interventions. The aims of this study were: (a) to examine access to psychotherapy for anxiety disorders in a sample of primary care patients; and (b) to examine individual factors associated with access to psychotherapy. Data were drawn from the "Dialogue" project, a large primary care study conducted in 67 primary care clinics. After a mental health screening, patients with anxiety or depressive symptoms were invited to participate in a telephone/Web structured interview to assess Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition (DSM-IV) anxiety and depressive disorders, as well as service utilization. In our sample, a total of 740 adults met DSM-IV criteria for panic disorder, generalized anxiety disorder or social anxiety disorder in the past 12 months. Nearly half of the respondents with anxiety disorders had received a form of psychotherapy or counselling in the past 12 months, and 20% of respondents reported at least 12 sessions with the same health care professional. Individual correlates of access to psychotherapy, based on a logistic regression model, included being a woman, less than 60 years old, a university education level, supplementary insurance and having a comorbid depression episode. These findings emphasize the need to improve access to psychotherapy for individuals with anxiety disorders in primary care and to reduce disparities in access to psychotherapy.

A qualitative study of perceived needs and factors associated with the quality of care for common mental disorders in patients with chronic diseases: the perspective of primary care clinicians and patients

“…In the context of our study, clinicians consistently voiced the lack of accessibility to psychotherapy as a barrier to offering this treatment option, and patients who did receive psychotherapy expressed their satisfaction or their desire to receive additional therapy. The access to psychotherapy is currently a challenge in the public system [ 15 , 49 ] and the reimbursement of psychotherapy services is highlighted as an avenue to expand access to psychotherapy services [ 50 ]. Patients’ preferences and readiness to introduce and adhere to psychological or pharmacological treatments for their anxiety or depression need to be closely assessed as these elements are essential to treatment initiation and treatment engagement.…”

La Direction générale de la pratique de la Société canadienne de psychologie : à la défense des intérêts de la psychologie partout au Canada

“…Au Canada, pour les parents , les enfants (Eichstedt et al, 2014 ;Hunsley et al, 2014), les étudiants de niveau postsecondaire (Nunes et al, 2014) et les adultes (Roberge et al, 2014), les services psychologiques sont très peu accessibles. Le rôle du psychologue est en train de changer dans le système de soins de santé, comme en témoignent l'intégration des psychologues aux équipes de soins primaires (p.…”

Incentives and disincentives for treating of depression and anxiety in Ontario Family Health Teams: protocol for a grounded theory study

“…32 33 Studies investigating the care for CMDs in primary care settings in Ontario have reported similar problems with under-recognition and inadequate treatment of these disorders. [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] Primary health care reforms in Canada In the early 2000s, provincial and territorial governments across Canada introduced several reforms aimed at strengthening primary care systems by improving access to care, quality of care, and the coordination and integration of services. 35 36 In Ontario, reform trends included a shift away from fee-for-service-based physician remuneration to a capitation-based system, patient enrolment to individual physicians, and the expansion of interprofessional team-based practices, primarily through the creation of Family Health Teams (FHTs).…”