[Anxiety disorders. The variability and determinants of the therapeutic approach of primary care physicians].

OBJECTIVES

To analyse the influence of independent factors, relating to the characteristics of primary care doctors, patients and the illness, on therapeutic attitudes and their variability before anxiety disorders.

DESIGN

Observational study of people attending primary care family medicine clinics who are identified as suffering anxiety disorders.

SETTING

The autonomous Communities of Castilla and Leon, the Basque Country and the Valencian Community.

PARTICIPANTS

3247 patients over 18 classified by their doctors as suffering an anxiety disorder.

MEASUREMENTS AND RESULTS

During 1995, 317 primary care doctors collected information from patients with anxiety disorders (CIE codes F40 and F41). The information was gathered with the same questionnaire in the three communities. The data were validated monthly before the final analysis. Women doctors gave less medical advice than male doctors (OR: 0.48, 95% CI: 0.36-0.65). Patients with anxiety in Castilla and Leon were at greater "risk" of receiving drugs treatment than those in the Basque Country (OR: 1.64, CI: 1.31-2.06). When the consultation was for any mental symptom or when the kind of anxiety was a panic disorder (OR: 2.39, CI: 1.53-3.65), phobic disorder (OR: 2.17, CI: 1.52-3.08) or mixed anxiety disorder (OR: 2.20, CI: 1.77-2.73), patients were more likely to be referred for specialist treatment. If it was decided to prescribe drugs treatment, women doctors used more often than their male colleagues a mixed treatment with anti-depressants, anxiolytic drugs and drugs for psychosis (OR: 1.60, CI: 160-4.28). Castilla and Leon, and the Valencian Community were less likely to use mixed treatment than the Basque Country reference group.

CONCLUSIONS

This study shows the variability in the difficulties encountered in diagnosis and finding a common standard of conduct for primary care doctors faced with patients suffering anxiety disorders. Although the treatment used for anxiety can be considered adequate in most cases, there is high variability, which depends mainly on the type and other characteristics of the process, the patient and the professional.