Understanding and Treating Panic Disorder in the Primary Care Setting

According to studies, the median prevalence of panic disorder in the primary care setting is 4%.Rates are higher among certain patient populations, such as those with cardiac (20% to 50%) or gastrointestinalpresentations (28% to 40%). Consequently, patients with panic disorder are high utilizersof medical services and are heavily represented among patients classified as high health care utilizers,compared with other psychiatric or non-psychiatric groups. Despite its frequency in the primary caresetting, panic disorder is significantly under-recognized by medical providers. Corresponding withinadequate recognition is the substantial proportion of these patients who fail to receive appropriatetreatment (pharmacotherapy and psychotherapy). Most experts have concluded that panic disorderis poorly managed in the primary care setting because of the process of care and patient engagement.In terms of process of care, primary care practice still operates on an acute disease model (leavingno time for initial patient education or follow-up), which is a poor fit for the management of chronicdiseases. Insufficient patient engagement in treatment (i.e., being involved in the treatment process,"buying into" rationale for treatment, and being willing to collaborate with clinician and adhere to recommendations)is the second important contributor to inadequate treatment. Use of a chronic diseaseself-management approach would enhance treatment of panic disorder. This model requires thatpatients, in collaboration with the health care provider/system, take day-to-day responsibility for managingtheir illness by doing 3 things: adhering to recommended medical management, adoptingimproved health habits/coping skills, and assisting in ongoing monitoring of illness status/change.Future approaches to treating panic disorder in primary care would be enhanced by includingassessments of patient beliefs and preferences, spending more time in preparing the patient for treatment,utilizing a simple pharmacotherapy algorithm, utilizing simple rating scales to monitor outcomes,and training providers in brief CBT interventions.