How to improve recognition, diagnosis and treatment of anxiety disorders in primary care: Results of the Dutch Breakthrough Collaborative

Henny Sinnema, Desiree Oosterbaan, Berend Terluin, Harriet van Wetten, Gerdien Franx, Anton van Balkom


Background: A guideline for patients with anxiety disorders is available in primary care. Providing care according guidelines can be improved. Our goal was to describe the results of a quality improvement method known as an Anxiety Breakthrough Collaborative, aimed at improving the uptake of the anxiety disorders guidelinein primary care. Methods: A stepped care model was implemented in an uncontrolled prospective implementation study. The study involved eight multidisciplinary primary care teams, consisting of 59 healthcare professionals. Implementation was measured by means of a set of process indicators. In addition, qualitative data were collected. Results: Screening patients who met high-risk criteria with the anxiety subscale of the Four-Dimensional Symptom Questionnairewas new for all teams.General practitioners succeeded in diagnosing the complexity of the anxiety disorder in 179 patients (98%). The proportion of patients with a non-complex disorder that received self-help or brief therapy increased from 44% to 67%. Against expectations, the proportion of patients with a complex anxiety disorder that received cognitive behavioral therapy and/or an antidepressant decreased slightly from 24% to 18%. Monitoring anxiety symptoms was rare. Collaboration between professionals improved in all teams. Conclusions: This study indicates that the Anxiety Disorders Breakthrough Collaborative may improve adherence to the anxiety disorders guideline. To sustain improvement, long-term collaboratives, financial support, and computerized decision support systems tailored to the work setting, including simple tools for monitoring patients, may be helpful. More insight and knowledge is required about which improvement strategies really contribute to the improvement of the quality of anxiety care. More robust study designs, including process evaluations, should be used to determine the impact of such strategies. 

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