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Treating Anxiety in the Primary Care Office Setting: Looking at Trends over 13 Years

June 8, 2023

Given the lack of adequate number of child psychiatrists, primary care pediatricians are finding themselves more often needing to diagnose and treat youth with internalizing disorders such as depression and anxiety. This week, Chavez et al (10.1542/peds.2022-059416) focus on office-based treatment of anxiety over a 13-year period (2006 to 2018). The authors analyzed data from the National Ambulatory Medical Care Survey looking at changes in the prevalence of primary care pediatricians diagnoses of anxiety and what methods of treatment (counseling therapies, medications, both or neither) were used over 3 time periods (2006-2009, 2010-2013, and 2014-2018). 

As you might expect, the proportion of office visits resulting in the diagnosis of anxiety increased from 1.4% in 2006-2009 to 4.2% in 2014-2018. While the proportion of visits increased, those receiving any form of counseling therapy as recommended by their primary care pediatrician decreased from 48.8% to 32.6% between the first and third time period, but without any significant change in overall rates of medications prescribed by the primary care clinician to treat anxiety. More patients were prescribed medication for anxiety in the more recent time interval than the earliest one. What can we learn from these findings to improve how we treat our patients with anxiety? The authors provide helpful thoughts based on their data analysis that will relieve your anxiety as to how to best diagnose and manage these patients in your office. Of note, the data in this study stopped just before the COVID-19 pandemic began. This will make you wonder what happened to these trends over the past few years. Hopefully, our journal will have the studies that answer this question in the year ahead.

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