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Telephone-based collaborative care program eases anxiety

March 01, 2017

PITTSBURGH, March 1, 2017 - A telephone-delivered collaborative care program for treating panic and generalized anxiety disorders in primary care is significantly more effective than doctors' usual care at improving health-related quality of life, anxiety and mood symptoms, according to a new study led by researchers at the University of Pittsburgh School of Medicine. These findings from the National Institutes of Health-funded Reduce Limitations from Anxiety (RELAX) trial were published in the March issue of the Journal of General Internal Medicine.

Researchers enrolled 329 patients 18 to 64 years old who were referred by their primary care physicians from six UPMC-affiliated practice locations. Approximately 250 patients were rated "highly anxious" and randomized to either the telephone-delivered intervention or to their primary care physician's usual care. The 79 other patients with "moderate" levels of anxiety symptoms were assigned to a "watchful waiting" group and later randomized if their anxiety symptoms worsened.

A study care manager regularly called patients in the intervention group to provide basic psycho-education; encourage healthy habits (sleep, exercise, avoid excess alcohol); assess treatment preferences for anti-anxiety medications; monitor response to treatment; and inform their primary care physicians of their care preference and progress.

At 12-months follow-up, anxiety symptoms remitted in 53 percent of intervention patients versus only 32 percent in patients who continued to receive their primary care physicians' usual care, and the intervention also produced similar significant improvements in health-related quality of life, panic and mood symptoms. These benefits persisted for another year after the intervention ended. African-Americans and men reported the greatest levels of improvement, and the 79 patients who reported moderate levels of anxiety at baseline generally did well over the course of follow-up, whether they were later randomized to the study intervention or not.

"While dozens of clinical trials have demonstrated the effectiveness of collaborative care for treating depression in primary care, comparatively few have addressed anxiety, despite their similar prevalence and adverse impact on health-related quality of life and excess utilization of health services," said Bruce L. Rollman, M.D., M.P.H., professor of medicine and director of Pitt's Center for Behavioral Health and Smart Technology. "Effective collaborative care for anxiety can be provided via telephone by college-educated, non-mental health care managers who follow an evidence-based treatment algorithm and work under the direction of a primary care physician."
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Others involved in the study include Bea Herbeck Belnap, Ph.D., Sati Mazumdar, Ph.D., Kaleab Abebe, Ph.D., and Jordan F. Karp, M.D., all of Pitt; Eric Lenze, M.D., Washington University School of Medicine in St. Louis; and Herbert Schulberg, Weill Cornell Medical College in White Plains, New York.

About the University of Pittsburgh School of Medicine

As one of the nation's leading academic centers for biomedical research, the University of Pittsburgh School of Medicine integrates advanced technology with basic science across a broad range of disciplines in a continuous quest to harness the power of new knowledge and improve the human condition. Driven mainly by the School of Medicine and its affiliates, Pitt has ranked among the top 10 recipients of funding from the National Institutes of Health since 1998. In rankings recently released by the National Science Foundation, Pitt ranked fifth among all American universities in total federal science and engineering research and development support.

Likewise, the School of Medicine is equally committed to advancing the quality and strength of its medical and graduate education programs, for which it is recognized as an innovative leader, and to training highly skilled, compassionate clinicians and creative scientists well-equipped to engage in world-class research. The School of Medicine is the academic partner of UPMC, which has collaborated with the University to raise the standard of medical excellence in Pittsburgh and to position health care as a driving force behind the region's economy. For more information about the School of Medicine, see http://www.medschool.pitt.edu.

About UPMC

A $14 billion world-renowned health care provider and insurer, Pittsburgh-based UPMC is inventing new models of patient-centered, cost-effective, accountable care. UPMC provides nearly $900 million a year in benefits to its communities, including more care to the region's most vulnerable citizens than any other health care institution. The largest nongovernmental employer in Pennsylvania, UPMC integrates 65,000 employees, more than 25 hospitals, 600 doctors' offices and outpatient sites, and a more than 3 million-member Insurance Services Division, the largest medical and behavioral health services insurer in western Pennsylvania. Affiliated with the University of Pittsburgh Schools of the Health Sciences, UPMC ranks No. 12 in the prestigious U.S. News & World Report annual Honor Roll of America's Best Hospitals. UPMC Enterprises functions as the innovation and commercialization arm of UPMC while UPMC International provides hands-on health care and management services with partners in 12 countries on four continents. For more information, go to UPMC.com.

http://www.upmc.com/media

University of Pittsburgh Schools of the Health Sciences

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