Eligible subjects were contacted by telephone, usually within 1 week (median = 7 days; mean = 9.6 sd 8.4 days) of enrollment to provide information about previous care received and satisfaction with that care.
Respondents were asked about the care they had received during the previous 6 months (i.e., prior to enrolling in the CALM study). These questions were modeled after those from our prior study 12 (link) augmented with questions about satisfaction with care. Using patient reports of the name and daily dosage of each prescribed medication they had “taken several times a week for at least a month in the last 6 months”, we derived separate indicators of (a) use of any psychotropic medication, (b) use of any anti-anxiety medication (i.e., antidepressant or benzodiazepine; or buspirone for GAD), (c) use of any anti-anxiety medication in an appropriate daily dosage for any duration, and (d) use of any anti-anxiety medication in appropriate daily dosage for at least 2 months. The latter was considered to meet the minimal criterion for “quality pharmacotherapy”. Determination of what was an anti-anxiety medication, and what was an appropriate daily dosage was made a priori by consensus of the psychiatrist investigators in the study, based on consensus statements and their collective knowledge of the evidence-based pharmacotherapy literature for anxiety.27 (link)
Using patient responses to questions about the content of outpatient visits with any provider in the prior 6 months, we derived separate indicators of (a) receipt of any psychotherapy, (b) receipt of psychotherapy with a CBT focus, i.e., at least 3 of 6 possible CBT elements (1: practice dealing with things that made you afraid; 2: teach you methods of relaxation; 3: helped you look at your thoughts more realistically; 4: help you see mistakes in your thinking; 5: help you understand how your thoughts and feelings are related; 6: ask you to do homework or practice between sessions) reported as covered at least “sometimes”, and (c) receipt of psychotherapy with an intensive CBT focus (i.e., at least 3 of 6 possible CBT elements reported as covered at least “usually”). Receipt of psychotherapy with a CBT focus (rather than the more rigorous definition involving an intensive CBT focus) was considered to meet the minimal criterion for “quality psychotherapy”.
Satisfaction with overall health care was assessed by asking respondents “How dissatisfied or satisfied were you with the health care available to you in the past 6 months?” Satisfaction with mental health care was assessed by asking “How dissatisfied or satisfied were you with the health care available to you for personal or emotional problems in the past 6 months?” Response choices for both questions were: very dissatisfied, dissatisfied, neither satisfied nor dissatisfied, satisfied, or very satisfied. The latter two responses were considered to reflect satisfaction with care for purposes of this report and the analyses described herein.
Respondents were asked about the care they had received during the previous 6 months (i.e., prior to enrolling in the CALM study). These questions were modeled after those from our prior study 12 (link) augmented with questions about satisfaction with care. Using patient reports of the name and daily dosage of each prescribed medication they had “taken several times a week for at least a month in the last 6 months”, we derived separate indicators of (a) use of any psychotropic medication, (b) use of any anti-anxiety medication (i.e., antidepressant or benzodiazepine; or buspirone for GAD), (c) use of any anti-anxiety medication in an appropriate daily dosage for any duration, and (d) use of any anti-anxiety medication in appropriate daily dosage for at least 2 months. The latter was considered to meet the minimal criterion for “quality pharmacotherapy”. Determination of what was an anti-anxiety medication, and what was an appropriate daily dosage was made a priori by consensus of the psychiatrist investigators in the study, based on consensus statements and their collective knowledge of the evidence-based pharmacotherapy literature for anxiety.27 (link)
Using patient responses to questions about the content of outpatient visits with any provider in the prior 6 months, we derived separate indicators of (a) receipt of any psychotherapy, (b) receipt of psychotherapy with a CBT focus, i.e., at least 3 of 6 possible CBT elements (1: practice dealing with things that made you afraid; 2: teach you methods of relaxation; 3: helped you look at your thoughts more realistically; 4: help you see mistakes in your thinking; 5: help you understand how your thoughts and feelings are related; 6: ask you to do homework or practice between sessions) reported as covered at least “sometimes”, and (c) receipt of psychotherapy with an intensive CBT focus (i.e., at least 3 of 6 possible CBT elements reported as covered at least “usually”). Receipt of psychotherapy with a CBT focus (rather than the more rigorous definition involving an intensive CBT focus) was considered to meet the minimal criterion for “quality psychotherapy”.
Satisfaction with overall health care was assessed by asking respondents “How dissatisfied or satisfied were you with the health care available to you in the past 6 months?” Satisfaction with mental health care was assessed by asking “How dissatisfied or satisfied were you with the health care available to you for personal or emotional problems in the past 6 months?” Response choices for both questions were: very dissatisfied, dissatisfied, neither satisfied nor dissatisfied, satisfied, or very satisfied. The latter two responses were considered to reflect satisfaction with care for purposes of this report and the analyses described herein.
