Generalized anxiety disorder in primary care. Patterns of healthcare utilization in Germany

Generalized Anxiety Disorder (GAD) has been described in community studies as a frequent and costly high utilizer group in the primary care sector. Administrative data supporting this observation are lacking so far. This paper reports utilization and prescription data of a nationally representative...

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Bibliographic Details
Published in:MMW Fortschritte der Medizin 2012-10, Vol.154 Suppl 3, p.77-84
Main Authors: Wittchen, H-U, Härtling, S, Dukes, E, Morlock, R, Edelsberg, J, Oster, G, Berger, A
Format: Article
Language:ger
Subjects:
Adult
Age Factors
Aged
Anti-Anxiety Agents - adverse effects
Anti-Anxiety Agents - therapeutic use
Antidepressive Agents - therapeutic use
Anxiety Disorders - drug therapy
Anxiety Disorders - epidemiology
Comorbidity
Delivery of Health Care - utilization
Depressive Disorder - drug therapy
Depressive Disorder - epidemiology
Female
Humans
Male
Middle Aged
National Health Programs - utilization
Sex Factors
Utilization Review
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Summary:Generalized Anxiety Disorder (GAD) has been described in community studies as a frequent and costly high utilizer group in the primary care sector. Administrative data supporting this observation are lacking so far. This paper reports utilization and prescription data of a nationally representative sample of over 900 primary care physicians, over 75 million prescriptions and 12-month utilization and prescription patterns of n = 3,340 GAD patients.These are compared to a matched control group without GAD, and without any anxiety or depressive disorder (n = 3,340). GAD patients in comparison to the matched controls revealed: (1) 2-fold increased primary care, (2) almost 3-fold specialist referrals, (3) almost 2-fold increased overall prescription rates, and (4) 3.5-fold increased sick certificates. However, only 58.3% of GAD patients were treated with any psychotropic medication. The data of this administrative-epidemiological cohort study support strongly the view that GAD ranks among the most costly high utilizer patient group in primary care in Germany. However, they are rarely treated according to evidence-based guidelines. The paper discusses these findings by suggesting that comorbid conditions might be a barrier for primary care physicians to initiate existing, more appropriate state of the art treatments.
ISSN:1438-3276