TY - JOUR
KW - Experiences and Patient Preferences
KW - Generalized Anxiety Disorder
KW - primary care
KW - Qualitative Evidence Synthesis
AU - A. Toledo-Chávarri
AU - V. Ramos-García
AU - A. Torres-Castaño
AU - M. M. Trujillo-Martín
AU - Peñate Castro
AU - I. Del Cura-Castro
AU - P. Serrano-Aguilar
AU - L. Perestelo-Perez
A1 - 
AB - BACKGROUND: Generalized anxiety disorder (GAD) is one of the most common mental disorders in primary care (PC). GAD has low remission and high relapse rates over long follow-up periods. Qualitative evidence was synthesized to understand the implementation of care and treatment options for people with GAD in PC. METHODS: Research published from 2008 to September 2020 was searched in five databases (MEDLINE, EMBASE, CINAHL, WOS and PsycArticles). Studies that used qualitative methods for data collection and analysis to investigate the implementation of care and treatment options for people with GAD in PC and outpatient settings were included. Non-qualitative studies, mixed methods studies that did not separately report qualitative findings and studies in languages other than English or Spanish were excluded. We used the Confidence in the Evidence from Reviews of Qualitative Research (CERQual) framework to assess the overall confidence in the findings. RESULTS: The results with a moderate level of confidence showed that the trajectory of care for people with GAD in PC and outpatient settings is long and fluctuates over time, involving multiple difficulties in accessing and maintaining initial treatment or successive treatment options. In addition, there are wide variations in the preferences for and acceptability of different treatment options. The results with a high level of confidence indicated that more information on GAD and its treatment options is needed for PC practitioners, GAD patients and their carers. The results with a low level of confidence suggested that patients use antidepressants for longer than recommended and that the interruption of treatment is not usually planned. CONCLUSIONS: Initial resistance to new treatments among people with GAD can make access and adherence to treatment difficult. Improving care may require patients to be informed of possible trajectories in stepped care pathways before the initiation of treatment so they are aware that they may need to try a number of options until the most effective treatment for them is found. Increased awareness of and information materials on GAD may facilitate both appropriate diagnosis and long-term care.
AD - Canary Islands Health Research Institute Foundation, Tenerife, Spain.; Research Network on Health Services in Chronic Diseases (REDISSEC), Madrid, Spain.; Center for Biomedical Research of the Canary Islands (CIBICAN), Tenerife, Spain.; The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Tenerife, Spain.; Canary Islands Health Research Institute Foundation, Tenerife, Spain. vanesa.ramosgarcia@sescs.es.; The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Tenerife, Spain. vanesa.ramosgarcia@sescs.es.; Canary Islands Health Research Institute Foundation, Tenerife, Spain.; The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Tenerife, Spain.; Canary Islands Health Research Institute Foundation, Tenerife, Spain.; Research Network on Health Services in Chronic Diseases (REDISSEC), Madrid, Spain.; Center for Biomedical Research of the Canary Islands (CIBICAN), Tenerife, Spain.; The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Tenerife, Spain.; Facultad de Ciencias de la Salud - Sección de Psicología, University of La Laguna, Tenerife, Spain.; Research Network on Health Services in Chronic Diseases (REDISSEC), Madrid, Spain.; Unidad de Apoyo a la Investigación, Gerencia Asistencial de Atención Primaria, Madrid, Spain.; Department Preventive Medicine and Public Health, University Rey Juan Carlos, Madrid, Spain.; Research Network on Health Services in Chronic Diseases (REDISSEC), Madrid, Spain.; Center for Biomedical Research of the Canary Islands (CIBICAN), Tenerife, Spain.; The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Tenerife, Spain.; Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain.; Research Ne(TRUNCATED)
BT - BMC family practice
C5 - Healthcare Disparities
CP - 1
DO - 10.1186/s12875-020-01307-6
IS - 1
JF - BMC family practice
LA - eng
M1 - Journal Article
N2 - BACKGROUND: Generalized anxiety disorder (GAD) is one of the most common mental disorders in primary care (PC). GAD has low remission and high relapse rates over long follow-up periods. Qualitative evidence was synthesized to understand the implementation of care and treatment options for people with GAD in PC. METHODS: Research published from 2008 to September 2020 was searched in five databases (MEDLINE, EMBASE, CINAHL, WOS and PsycArticles). Studies that used qualitative methods for data collection and analysis to investigate the implementation of care and treatment options for people with GAD in PC and outpatient settings were included. Non-qualitative studies, mixed methods studies that did not separately report qualitative findings and studies in languages other than English or Spanish were excluded. We used the Confidence in the Evidence from Reviews of Qualitative Research (CERQual) framework to assess the overall confidence in the findings. RESULTS: The results with a moderate level of confidence showed that the trajectory of care for people with GAD in PC and outpatient settings is long and fluctuates over time, involving multiple difficulties in accessing and maintaining initial treatment or successive treatment options. In addition, there are wide variations in the preferences for and acceptability of different treatment options. The results with a high level of confidence indicated that more information on GAD and its treatment options is needed for PC practitioners, GAD patients and their carers. The results with a low level of confidence suggested that patients use antidepressants for longer than recommended and that the interruption of treatment is not usually planned. CONCLUSIONS: Initial resistance to new treatments among people with GAD can make access and adherence to treatment difficult. Improving care may require patients to be informed of possible trajectories in stepped care pathways before the initiation of treatment so they are aware that they may need to try a number of options until the most effective treatment for them is found. Increased awareness of and information materials on GAD may facilitate both appropriate diagnosis and long-term care.
PY - 2020
SN - 1471-2296; 1471-2296
SP - 237
T1 - Framing the process in the implementation of care for people with generalized anxiety disorder in primary care: a qualitative evidence synthesis
T2 - BMC family practice
TI - Framing the process in the implementation of care for people with generalized anxiety disorder in primary care: a qualitative evidence synthesis
U1 - Healthcare Disparities
U2 - 33218311
U3 - 10.1186/s12875-020-01307-6
VL - 21
VO - 1471-2296; 1471-2296
Y1 - 2020
Y2 - Nov 20
ER -