Undertreatment of Panic Disorder in Primary Care: Role of Patient and Physician Characteristics

Peter Roy-Byrne, MD, Joan Russo, PhD, David C. Dugdale, MD, Daniel Lessler, MD, Deborah Cowley, MD, Wayne Katon, MD


J Am Board Fam Med. 2002;15(6) 

In This Article

Abstract and Introduction

Background: In contrast with many studies describing the usual care for major depression in the pri mary care setting, there are few data on treatment received by primary care patients with panic disorder.
Methods: This prospective cohort study describes the self-reported medication use, at 3-month intervals for 1 year, of 58 patients with panic disorder and predictors of the use of appropriate (type, dose, and duration) medication.
Results: Approximately one half the patients received some type of antipanic medication at each interval, with selective serotonin reuptake inhibitors (SSRIs) the most common. Pharmacy records indicate that about 40% of patients not taking medication had received an initial physician prescription. Adequacy of dose and duration was achieved in only two thirds of the medication trials, usually with an SSRI. Patient characteristics (agoraphobia and low neuroticism) but not physician characteristics (eg, specialty, level of training, or years in practice) predicted those patients who had an adequate trial during at least one time interval. The relation between adequacy of medication and outcome was minimal.
Conclusion: These findings highlight the continued undertreatment of panic disorder in primary care but suggest that focused efforts at physician education about diagnosis and treatment are less likely to increase rates of treatment compared with efforts to educate patients and improve the care process with more frequent visits and monitoring.

As is major depression, panic disorder is commonly treated in the primary care setting, with more than 80% of patients with panic disorder complaining of such physical symptoms as chest pain, tachycardia, or dyspnea.[1] Of patients receiving care for mental and emotional problems, a greater proportion of patients with panic disorder receive their care in medical settings (46%) than do depressed patients (32%).[2] In contrast with a growing literature describing the characteristics of usual care for major depression in the primary care setting,[3,4,5,6,7] there are few data on treatment received by patients with panic disorder in the primary care setting.

Only two published studies describe treatment received by patients in this setting,[8,9] and in one of these studies, patients with panic disorder were not distinguished from patients with generalized anxiety or phobic disorder. These two reports only describe the type and the adequacy of treatment using patient self-report. Neither study determined how much the lack of recognition of panic disorder might have contributed to the absence of treatment, neither was able to describe treatment over time, neither examined how patient and clinician characteristics related to the adequacy of treatment, and neither systematically examined the outcome of treatment and its relation to quality of care.

In this article, we use patient self-reports to document the type and adequacy of pharmacotherapy and the use of specialty mental health services (a likely proxy for psychotherapy) for patients with panic disorder treated by primary care physicians. We also report associations between physician and patient variables and the adequacy of medication received, as well as between adequacy of medication and clinical and functional outcomes at 3-month intervals for the 1-year study period.


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