Collaborative care for panic disorder, generalised anxiety disorder and social phobia in general practice: study protocol for three cluster-randomised, superiority trials

Abstract

BackgroundPeople with anxiety disorders represent a significant part of a general practitioner’s patient population. However, there are organisational obstacles for optimal treatment, such as a lack of coordination of illness management and limited access to evidence-based treatment such as cognitive behavioral therapy. A limited number of studies suggest that collaborative care has a positive effect on symptoms for people with anxiety disorders. However, most studies are carried out in the USA and none have reported results for social phobia or generalised anxiety disorder separately. Thus, there is a need for studies carried out in different settings for specific anxiety populations.A Danish model for collaborative care (the Collabri model) has been developed for people diagnosed with depression or anxiety disorders. The model is evaluated through four trials, of which three will be outlined in this protocol and focus on panic disorder, generalised anxiety disorder and social phobia. The aim is to investigate whether treatment according to the Collabri model has a better effect than usual treatment on symptoms when provided to people with anxiety disorders.MethodsThree cluster-randomised, clinical superiority trials are set up to investigate treatment according to the Collabri model for collaborative care compared to treatment-as-usual for 364 patients diagnosed with panic disorder, generalised anxiety disorder and social phobia, respectively (total n = 1092). Patients are recruited from general practices located in the Capital Region of Denmark. For all trials, the primary outcome is anxiety symptoms (Beck Anxiety Inventory (BAI)) 6 months after baseline. Secondary outcomes include BAI after 15 months, depression symptoms (Beck Depression Inventory) after 6 months, level of psychosocial functioning (Global Assessment of Functioning) and general psychological symptoms (Symptom Checklist-90-R) after 6 and 15 months.DiscussionResults will add to the limited pool of information about collaborative care for patients with anxiety disorders. To our knowledge, these will be the first carried out in a Danish context and the first to report results for generalised anxiety and social phobia separately. If the trials show positive results, they could contribute to the improvement of future treatment of anxiety disorders.Trial registrationClinicalTrials.gov, ID: NCT02678624. Retrospectively registered 7 February 2016; last updated 15 August 2016,Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-2120-3) contains supplementary material, which is available to authorized users.

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The allocation of resources in the care for patients with panic disorder in Germany: an excess cost analysis informing policy and science

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Collaborative care vs consultation liaison for depression and anxiety disorders in general practice: study protocol for two randomized controlled trials (the Danish Collabri Flex trials)

“…The collaborative care model tested in the trials is based on the former Collabri model [24, 25] and has been updated to incorporate key knowledge and experiences from the Collabri anxiety and depression trials. The Collabri Flex model complies with the collaborative care criteria [18, 19] in the following way: The model proposes a multi-professional approach to treatment that involves a GP, a care manager and a psychiatrist.The inter-professional communication is promoted through planned, regular contact.…”

“…As part of the HTA, a Danish collaborative care model for anxiety and depression was developed. Between 2014 and early 2017 the model was tested in the Capital Region of Denmark in four cluster-randomized superiority trials (the Collabri trials) comparing collaborative care with treatment as usual for depression, generalized anxiety disorder, social anxiety disorder and panic disorder [24, 25]. As collaborative care involves activities on the organizational level, such as ongoing supervision and support of the general practitioner (GP) by mental-health specialists, cluster randomization was chosen because of the considerable risk of control group contamination if randomization was performed on an individual level [26].…”