{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:51:25Z","timestamp":1760147485439,"version":"3.44.0"},"reference-count":19,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Qual"],"accepted":{"date-parts":[[2017,11,21]]},"published-print":{"date-parts":[[2018,1]]},"abstract":"<jats:p>Primary care patients frequently present with anxiety with prevalence ratios up to 30%. Brief cognitive\u2013behavioural therapy (CBT) has been shown in meta-analytic studies to have a strong effect size in the treatment of anxiety. However, in surveys of anxious primary care patients, nearly 80% indicated that they had not received CBT. In 2010, a model of CBT (Coordinated Anxiety Learning and Management (CALM)) adapted to primary care for adult anxiety was published based on results of a randomised controlled trial. This project aimed to integrate an adaptation of CALM into one primary care practice, using results from the published research as a benchmark with the secondary intent to spread a successful model to other practices. A quality improvement approach was used to translate the CALM model of CBT for anxiety into one primary care clinic. Plan-Do-Study-Act steps are highlighted as important steps towards our goal of comparing our outcomes with benchmarks from original research. Patients with anxiety as measured by a score of 10 or higher on the Generalized Anxiety Disorder 7 item scale (GAD-7) were offered CBT as delivered by licensed social workers with support by a PhD psychologist. Outcomes were tracked and entered into an electronic registry, which became a critical tool upon which to adapt and improve our delivery of psychotherapy to our patient population. Challenges and adaptations to the model are discussed. Our 6-month response rates on the GAD-7 were 51%, which was comparable with that of the original research (57%). Quality improvement methods were critical in discovering which adaptations were needed before spread. Among these, embedding a process of measurement and data entry and ongoing feedback to patients and therapists using this data are critical step towards sustaining and improving the delivery of CBT in primary care.<\/jats:p>","DOI":"10.1136\/bmjoq-2017-000066","type":"journal-article","created":{"date-parts":[[2018,1,9]],"date-time":"2018-01-09T20:20:32Z","timestamp":1515529232000},"page":"e000066","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["A quality improvement project aimed at adapting primary care to ensure the delivery of evidence-based psychotherapy for adult anxiety"],"prefix":"10.1136","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3580-2818","authenticated-orcid":false,"given":"Mark D","family":"Williams","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Craig N","family":"Sawchuk","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathan D","family":"Shippee","sequence":"additional","affiliation":[{"name":"Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristin J","family":"Somers","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Summer L","family":"Berg","sequence":"additional","affiliation":[{"name":"Department of Social Work, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jay D","family":"Mitchell","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angela B","family":"Mattson","sequence":"additional","affiliation":[{"name":"Department of Nursing, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David J","family":"Katzelnick","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,1,9]]},"reference":[{"key":"2025083113431909000_7.1.e000066.1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2010.608"},{"key":"2025083113431909000_7.1.e000066.2","doi-asserted-by":"crossref","first-page":"970","DOI":"10.4088\/JCP.09m05626blu","article-title":"Quality of and patient satisfaction with primary health care for anxiety disorders","volume":"72","author":"Stein","year":"2011","journal-title":"J Clin Psychiatry"},{"key":"2025083113431909000_7.1.e000066.3","doi-asserted-by":"publisher","DOI":"10.1007\/s10608-012-9476-1"},{"key":"2025083113431909000_7.1.e000066.4","first-page":"168","article-title":"Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization\u2019s World Mental Health Survey Initiative","volume":"6","author":"Kessler","year":"2007","journal-title":"World Psychiatry"},{"key":"2025083113431909000_7.1.e000066.5","doi-asserted-by":"publisher","DOI":"10.1186\/1741-7015-8-38"},{"key":"2025083113431909000_7.1.e000066.6","first-page":"1285","article-title":"Training primary care physicians in cognitive behavioral therapy: a review of the literature. Patient education and counseling","volume":"99","author":"Dorflinger","year":"2016","journal-title":"Review"},{"key":"2025083113431909000_7.1.e000066.7","doi-asserted-by":"publisher","DOI":"10.1093\/fampra\/cmu060"},{"key":"2025083113431909000_7.1.e000066.8","doi-asserted-by":"publisher","DOI":"10.1002\/da.20542"},{"key":"2025083113431909000_7.1.e000066.9","doi-asserted-by":"publisher","DOI":"10.1001\/archgenpsychiatry.2011.25"},{"key":"2025083113431909000_7.1.e000066.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.genhosppsych.2007.04.005"},{"key":"2025083113431909000_7.1.e000066.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.genhosppsych.2011.04.011"},{"key":"2025083113431909000_7.1.e000066.12","doi-asserted-by":"crossref","first-page":"1-11","DOI":"10.1186\/1748-5908-7-14","article-title":"Implementation of the CALM intervention for anxiety disorders: a qualitative study","volume":"7","author":"Curran","year":"2012","journal-title":"Implement Sci"},{"key":"2025083113431909000_7.1.e000066.13","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291700048017"},{"key":"2025083113431909000_7.1.e000066.14","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.166.10.1092"},{"issue":"Suppl 20","key":"2025083113431909000_7.1.e000066.15","first-page":"22","article-title":"The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10","volume":"59 Suppl 20","author":"Sheehan","year":"1998","journal-title":"J Clin Psychiatry"},{"key":"2025083113431909000_7.1.e000066.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.genhosppsych.2013.06.011"},{"key":"2025083113431909000_7.1.e000066.17","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-128-8-199804150-00009"},{"key":"2025083113431909000_7.1.e000066.18","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1037\/a0026559","article-title":"What cognitive behavioral techniques do therapists report using when delivering cognitive behavioral therapy for the eating disorders?","volume":"80","author":"Waller","year":"2012","journal-title":"J Consult Clin Psychol"},{"key":"2025083113431909000_7.1.e000066.19","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1007\/s10488-015-0710-5","article-title":"Feedback from outcome measures and treatment effectiveness, treatment efficiency, and collaborative practice: a systematic review","volume":"43","author":"Gondek","year":"2016","journal-title":"Adm Policy Ment Health"}],"container-title":["BMJ Open Quality"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjoq-2017-000066","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T20:43:28Z","timestamp":1756673008000},"score":1,"resource":{"primary":{"URL":"https:\/\/qir.bmj.com\/lookup\/doi\/10.1136\/bmjoq-2017-000066"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,1]]},"references-count":19,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2018,1,9]]},"published-print":{"date-parts":[[2018,1]]}},"alternative-id":["10.1136\/bmjoq-2017-000066"],"URL":"https:\/\/doi.org\/10.1136\/bmjoq-2017-000066","relation":{},"ISSN":["2399-6641"],"issn-type":[{"type":"electronic","value":"2399-6641"}],"subject":[],"published":{"date-parts":[[2018,1]]}}}