Article type
Abstract
"Background: Singapore launched its National Mental Health and Well-Being Strategy in 2023, aiming to create an effective mental health ecosystem including accessible and good quality clinical care. Generalised anxiety disorder (GAD) was identified as a priority for primary care clinical guidance, due to the rising prevalence and reported care gaps including episodic treatment and care practice variations.
Objectives: To inform the scoping of the proposed ACE clinical guidance (ACG) through structured engagement with local primary care physicians (PCPs) to describe current practices and associated challenges in GAD care.
Methods: An online survey was conducted among PCPs from public and private settings in August 2023. The 17-item questionnaire covered GAD care aspects including screening, diagnosis, management, and referral. No consumers were involved.
Results: A total of 69 survey responses were received, with majority practicing in public primary care - polyclinics (72.5%), and seeing more than 50 patients per week (85.5%). The survey findings enhanced our understanding of the needs and gaps of GAD management in local primary care. For example, cognitive behavioural therapy (CBT) is a recommended first-line treatment option alongside pharmacotherapy based on latest evidence. However, 81% of surveyed PCPs would refer their GAD patients elsewhere for psychotherapies including CBT, with the main perceived barriers being patient-related factors (55%) and uncertainty about the choice (46%) or effectiveness (26%) of psychotherapies (Figure 1). As part of the national tiered care model, PCPs are not expected to conduct psychotherapy, but understanding the principles and importance of psychotherapy in managing GAD are instrumental for PCPs to facilitate patient access to relevant resources, and hence warrants its inclusion in the ACG scope. In addition, the survey highlighted areas where PCPs may need additional guidance, such as suicidal risk assessment and digital self-help (Figure 2).
Conclusions: The ACG will provide guidance on biopsychosocial assessment and management of GAD in primary care, particularly addressing potential knowledge gaps identified. Early end user involvement – PCPs – in the scoping phase ensures ACG’s applicability and usability in the local context. The limited private sector representation warrants further discussing the findings with private PCP experts when formulating clinical recommendations. "
Objectives: To inform the scoping of the proposed ACE clinical guidance (ACG) through structured engagement with local primary care physicians (PCPs) to describe current practices and associated challenges in GAD care.
Methods: An online survey was conducted among PCPs from public and private settings in August 2023. The 17-item questionnaire covered GAD care aspects including screening, diagnosis, management, and referral. No consumers were involved.
Results: A total of 69 survey responses were received, with majority practicing in public primary care - polyclinics (72.5%), and seeing more than 50 patients per week (85.5%). The survey findings enhanced our understanding of the needs and gaps of GAD management in local primary care. For example, cognitive behavioural therapy (CBT) is a recommended first-line treatment option alongside pharmacotherapy based on latest evidence. However, 81% of surveyed PCPs would refer their GAD patients elsewhere for psychotherapies including CBT, with the main perceived barriers being patient-related factors (55%) and uncertainty about the choice (46%) or effectiveness (26%) of psychotherapies (Figure 1). As part of the national tiered care model, PCPs are not expected to conduct psychotherapy, but understanding the principles and importance of psychotherapy in managing GAD are instrumental for PCPs to facilitate patient access to relevant resources, and hence warrants its inclusion in the ACG scope. In addition, the survey highlighted areas where PCPs may need additional guidance, such as suicidal risk assessment and digital self-help (Figure 2).
Conclusions: The ACG will provide guidance on biopsychosocial assessment and management of GAD in primary care, particularly addressing potential knowledge gaps identified. Early end user involvement – PCPs – in the scoping phase ensures ACG’s applicability and usability in the local context. The limited private sector representation warrants further discussing the findings with private PCP experts when formulating clinical recommendations. "