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Influence of morbidity and the use of health resources in patients who require care for generalised anxiety disorder in the primary health care setting

Aten Primaria 40:603-610. Published in Spanish.

Dirección de Planificación. Badalona Serveis Assistencials, S.A. Badalona. Barcelona, Spain

OBJECTIVE: To evaluate the co-morbidity, health care use, economical impact, and availability of effective treatments used in generalised anxiety disorder (GAD) patients in a primary care setting (PCS).

METHOD: A retrospective multicentre population-based study.

SETTING: Five primary care clinics managed by Badalona Serveis Assistencials S.A., Barcelona, Spain.

PARTICIPANTS: Outpatient records of patients over 18 years managed at 5 PCSs during 2006. Patients with and without GAD were compared. In GAD patients, 4 groups were established for comparison, according to pharmacological prescription.

MEASUREMENTS: Main outcomes measures were general, reason/co-morbidity, health care use and primary care cost (visits, diagnostic/therapeutic tests, and drugs). We counted work absenteeism as an indirect cost. Pharmacological prescription was studied according to evidence-based recommendations and Spanish health-approved indications. The statistical analysis included a multivariate model: logistic regression, analysis of covariance (ANCOVA), P .05.

RESULTS. Of the 65 767 patients included, 4.6% (95% confidence interval [CI], 3.9-5.3) had GAD. Patients with/without GAD, the average episode/year was 6.1 versus 4.7 and attendance/year 10.0 versus 7.6; P .001. GAD was associated with women (odds ratio [OR], 1.8), dyslipidemia (OR, 1.2), smoking (OR, 1.4), depression (OR, 1.2), and cerebrovascular accident (OR, 1.6) (P .02). The mean direct cost/year adjusted y age, gender and morbiity load was euro686 versus euro557 (P .001). GAD was associated with higher directs costs. The recommended treatment was followed in 40.1% o total patients (95% CI, 38.4-41.8).

CONCLUSIONS: Patients with GAD have greater co-morbidity and higher direct costs in PCS. Means designed to improve the recognition and treatment of these patients should be established in the PCS.

PMID: 19100147