What’s Next: CALM

Objective

Building on previous depression studies, our recently completed primary care panic study (CCAP), and key-informant interviews of primary care providers, patients, and clinic administrators, CALM (Coordinated Anxiety Learning and Management) has been designed as a definitive effectiveness study for primary care anxiety disorders that will establish the foundation needed for future dissemination of quality of care improvements for primary care anxiety.

Improvements to the model

Responding to requests from primary care providers, the model is broader in scope and now includes all four anxiety disorders prevalent in primary care (i.e., panic disorder [PD], generalized anxiety disorder [GAD], social anxiety disorder [SAD] and posttraumatic stress disorder [PTSD]), as well as patients with depression and/or moderate substance use disorder comorbidity. To maximize generalizability, it includes diverse populations in community-based settings and monolingual Spanish speakers. The model has been improved to enhance the effectiveness of care by allowing patients to choose their preferred treatment modality, CBT or medication, using techniques to maximize treatment engagement, and addressing therapeutic non-response with the use of stepped care algorithms. Finally, to facilitate future intervention uptake, the study will gather key-informant information to document acceptability of the service delivery model for disadvantaged populations and for clinic organization and personnel. These features are intended to enhance the acceptability, clinical effectiveness, and generalizability of our approach.

Key Researchers and Sites

CALM brings together a group of efficacy and effectiveness researchers with different skills to design and implement a model of delivering evidence based treatments to improve outcomes for multiple anxiety disorders in primary care. The original CCAP PI group has been expanded to include a fourth clinical site at the University of Arkansas and a data management and analysis site at RAND. The PIs for these sites, Greer Sullivan, MD, MSPH at the University of Arkansas, and Cathy Sherbourne, PhD at RAND, are not new to this project. Dr. Sullivan was a consultant to the CCAP study from its inception, and Dr. Sherbourne was vital participant to all aspects of the grant specializing in the data management and analysis as well as quality of life assessment and interpretation. The collaborative research group continues to include Peter Roy-Byrne, MD as the PI at University of Washington, Michelle Craske, PhD as the PI at UCLA, and Murray Stein, MD, MPH as the PI at UCSD. In total, 13 outpatient clinics will participate in this study, each administratively linked to one of the 4 clinical sites. RAND will collect outcomes data via telephone and conduct data analysis. Web-based information systems, previously used in the IMPACT study of depression in primary care, will be adapted to monitor recruitment, enrollment, and various other processes during the study. A steering committee of the PIs, chaired by Dr. Roy-Byrne, will finalize study design and procedures, oversee study implementation and quality control, and facilitate data analysis and dissemination of results.