Anxiety and Depression Among Primary Care Patients in Riyadh

DETECTION OF ANXIETY DISORDERS IN PRIMARY CARE: A META-ANALYSIS OF ASSISTED AND UNASSISTED DIAGNOSES

BACKGROUND

Evidence suggests that general practitioners (GPs) fail to diagnose up to half of common mental disorder cases. Yet no previous research has systematically summarized the evidence in the case of anxiety disorders. The aim of this review was to systematically assess and meta-analyze the diagnostic accuracy of GPs' assisted (i.e., using severity scales/diagnostic instruments) and unassisted (without such tools) diagnoses of anxiety disorders.

METHODS

Systematic review (PROSPERO registry CRD42013006736) was conducted. Embase, Ovid Journals--Ovid SP Medline, Pubmed, PsycINFO, Scopus, Web of Science, and Science Direct were searched from January 1980 through June 2014. Seven investigators, working in pairs, evaluated studies for eligibility. The quality of included studies was assessed with the Quality Assessment of Diagnostic Accuracy Studies tool version 2 (QUADAS-2). The main outcome measures were sensitivity and specificity of clinical diagnoses of any anxiety disorder. We pooled sensitivity and specificity levels from included studies using bivariate meta-analyses.

RESULTS

Twenty-four studies were included in the meta-analysis with a total sample of 34,902 patients. Pooled sensitivity and specificity were estimated at 44.5% (95% CI 33.7-55.9%) and 90.8% (95% CI 87-93.5%). GPs' sensitivity was higher when diagnoses were assisted (63.6%, 95% CI 50.3-75.1%) than when unassisted (30.5%, 95% CI 20.7-42.5%) to the expense of some specificity loss (87.9%, 95% CI 81.3-92.4% vs. 91.4%, 95% CI 86.6-94.6%, respectively). Identification rates remained constant over time (P-value = .998).

CONCLUSIONS

The use of diagnostic tools might improve detection of anxiety disorders in "primary care."

Audit of prescribing patterns in Saudi primary health care: What lessons can be learned?

BACKGROUND

The prescription of drugs is one of the most important factors in the rising costs of health services. The lack of proven benefit, and the definite cost and side effects of many prescriptions, have been found in many studies. The aim of the present study is to assess the prescribing pattern of primary health care (PHC) physicians in Riyadh city, the capital of Saudi Arabia.

PATIENTS AND METHODS

Prescriptions issued from eight PHC centers over two weeks (six months apart) were analyzed. The health centers were randomly selected to represent the geographical parts of Riyadh city.

RESULTS

A total of 17,067 prescriptions were analyzed. The most frequently prescribed drugs were antihistamines (25%), paracetamol (20.3%) and antibiotics (14.7%). Upper respiratory tract infection (URTI) was the diagnostic label used on more than half of the prescriptions. On the other hand, drugs for chronic illnesses such as diabetes mellitus (DM) and hypertension were written in a minority of the prescriptions. Antibiotics were prescribed for 26% and antihistamines for 28% of patients with URTI. Although it is well known that a large proportion of patients seen in PHC have a significant psychological or psychiatric disorder, no diagnoses of mental disorders were made.

CONCLUSION

There is a pressing need for education of both patients and doctors regarding the benefit of treatment and control of chronic illnesses, and the limited contribution that the doctor or an antibiotic can make to many self-limiting conditions like URTI. Doctors should be educated on more appropriate and cost-effective prescribing. The detection and management of psychological disorders need special emphasis.