Predictors of treatment satisfaction among older adults with anxiety in a primary care psychology program

Abstract

Increasing numbers of patients are treated in integrated primary care mental health programs. The current study examined predictors of satisfaction with treatment in patients from a randomized clinical trial of late-life generalized anxiety disorder (GAD) in primary care. Higher treatment satisfaction was associated with receiving CBT rather than enhanced usual care. Treatment credibility, treatment expectancies, social support, and improvements in depression and anxiety symptoms predicted higher treatment satisfaction in the total sample. In the CBT group, only credibility and adherence with treatment predicted satisfaction. This suggests that older patients receiving CBT who believe more strongly in the treatment rationale and follow the therapist’s recommendations more closely are likely to report satisfaction at the end of treatment. In addition, this study found that adherence mediated the relationship between treatment credibility and treatment satisfaction. In other words, patients’ perceptions that the treatment made sense for them led to greater treatment adherence which then increased their satisfaction with treatment.

The Impact of Loneliness on Quality of Life and Patient Satisfaction Among Older, Sicker Adults

“…To date, no studies have considered the impact of loneliness on patient satisfaction. However, our results are consistent with other studies that have demonstrated that anxiety (Hundt et al, 2013; Stein et al, 2011) and mental health treatments (Chen et al, 2006; Hasler et al, 2004; Lippens & Mackenzie, 2011) are often associated with reduced patient satisfaction. In these studies, symptom improvement and social support played a significant role in both treatment satisfaction and perceived effectiveness (Hasler et al, 2004; Hundt et al, 2013; Lippens & Mackenzie, 2011; Shea et al, 2007).…”

“…More recently, patient satisfaction has become a measure of quality of care in the United States (Chen et al, 2006; Hundt et al, 2013; Stein et al, 2011) as well as other countries (Hasler et al, 2004; Lippens & Mackenzie, 2011). Furthermore, provider and health insurance reimbursement rates in the United States are often tied to patient satisfaction.…”

“…In these studies, measures and definitions of QOL were not consistent; however, results generally indicated that loneliness decreased QOL (Dahlberg & McKee, 2014; Golden et al, 2009; Lim & Kua, 2011; Taube et al, 2014; van Beljouw et al, 2014). In addition, the impact of loneliness on patient satisfaction with medical services (e.g., physician or insurance plans) has not been examined, although several studies have shown that anxiety decreases patient satisfaction specifically with mental health services (Hundt et al, 2013; Stein et al, 2011). …”

Systematic Review of the Clinical Application of Exposure Techniques to Community-Dwelling Older Adults with Anxiety

“…For moderate intensity treatments, some data was available: younger age (Ayers et al, 2011), better perceived health (Schuurmans, 2009), lower neuroticism (Schuurmans et al, 2009), higher baseline symptoms (Wetherell et al, 2005b), presence of a comorbid diagnosis (Wetherell, Sorrell, Thorp & Patterson, 2005b), absence of subtle cognitive deficits or executive skill deficits (Caudle, 2007; Mohlman & Gorman, 2005), treatment credibility and homework adherence (Ayers et al, 2011, Gorenstein, et al, 2005, and Wetherell et al, 2005b). Likewise, for low intensity treatments, the following predictors of positive treatment outcome were identified: age ≥ than 60 years of age (Hui & Zhihui, 2016), shorter duration of illness (Hui & Zhihui, 2016), higher baseline levels of avoidance (Hui & Zhihui, 2016), treatment credibility (Hundt, 2013, Jones et al, 2016), homework adherence (Hundt et al, 2013), reduction in anxiety symptoms early in treatment (Bradford et al, 2011), and improvement in executive functioning during the course of treatment (Mohlman et al, 2008). …”

The role of homework in exposure-based CBT outcome for problem gambling

“…Nordgreen et al (2012) observed an association between treatment credibility and treatment adherence among socially anxious individuals engaged in a CBT self-help program. More recently Hundt et al (2013) demonstrated that treatment credibility among anxious patients undergoing CBT, was associated with greater treatment adherence which in turn predicted patients' satisfaction with treatment. To date the relationships between non-specific factors such as treatment expectancy and credibility, and CBT outcomes for PG have received little attention.…”