ANXIETY POORLY MANAGED IN HOSPITALIZED PATIENTS, STUDY REPORTS
COLUMBUS, Ohio – Anxiety is often poorly managed in patients recovering from a heart attack, new research reports.
While medical records revealed that nearly three-quarters of 101 patients in the study had received some sort of treatment for anxiety, symptoms of anxiety were documented on less than half of the patients’ charts.
“Some of these people were treated for anxiety even though there was nothing in their chart to suggest they were anxious to begin with,” said Susan Frazier, the lead author of the study, which appears in a recent issue of the journal Heart and Lung. Frazier is an associate professor of nursing at Ohio State University.
She and her colleagues also found that patients’ own reports of anxiety often weren’t documented on their medical charts. Anxiety levels varied from none to severe among the participants, according to their self-reports.
“Anxiety is seen as subjective by many healthcare practitioners,” Frazier said. “And it wasn’t systematically or accurately evaluated by most of the clinicians in this study. Undetected or poorly managed anxiety can hurt a patient’s recovery.”
Patients reporting no feelings of anxiety were less likely to receive anxiolytic medication – drugs that help subdue anxiety – than were patients who felt mildly, moderately or extremely anxious. Still, in most of these latter cases, there was no correlation between the clinician’s rating of a patient’s anxiety level and the administration of treatment for anxiety.
“The clinicians based drug treatment and other anxiety-control strategies on inaccurate evaluations of participants’ anxiety levels,” Frazier said. “Hospitalized patients can’t expect to receive proper treatment for anxiety without some sort of systematic evaluation, and that won’t happen until caregivers use objective measures to evaluate anxiety.”
Frazier said that she and her colleagues are working on developing a tool that will help establish clear, objective measures for evaluating patient anxiety.
In the study, hospitalized patients recovering from a heart attack answered a series of open-ended statements that helped the researchers determine how calm, anxious, tense, satisfied, worried, etc., a patient felt.
The researchers then scored the answers and put each patient – based on their scores – into one of four groups: no anxiety, mild anxiety, moderate anxiety and extreme anxiety. Each group contained about the same number of participants.
Nearly half of the patients who had rated themselves as feeling extremely anxious had not undergone a clinical assessment of anxiety. Nor had more than half of the patients in both the moderate anxiety and mild anxiety groups undergone an anxiety assessment.
Slightly less than one-third of the patients who reported feeling no anxiety had been evaluated for anxiety by a clinician.
Frazier and her colleagues compared a patient’s questionnaire results to what was written on their medical chart. The researchers looked at the charts for evidence of whether or not anxiety had been addressed or treated. Treatments included the administration of anxiolytic and/or pain medications and non-drug techniques, such as relaxation therapy and reassurance. The researchers also looked for evidence of follow-up visits in which a doctor or nurse would evaluate the effectiveness of the prescribed intervention and if the clinician had consulted with another healthcare provider for help in managing a patient’s anxiety.
The charts showed that nearly three-quarters (72) of the 101 participants had received some sort of treatment for anxiety. But anxiety was actually assessed by a clinician in less than half (45) of all of the patients.
“It’s clear that the clinicians who cared for patients in this study did not adequately diagnose anxiety in order to get an accurate representation of how their patient truly felt,” Frazier said.
Only 15 out of 39 patients given anxiolytic medication had information in their charts describing how effective the medication was in controlling anxiety. Medication was given mainly to patients who clinicians had decided were anxious. Nearly all of the patients (99) were given pain medication.
Doctors and nurses treated fewer than half (46) of the patients with non-drug anxiety management techniques, including supportive therapy and reassurance.
“These strategies were written simply as ‘supportive therapy’ and usually lacked further description,” said Frazier, adding that these techniques were usually used on patients who reported feeling little or no anxiety.
Only one participant’s medical chart contained follow-up information on the effectiveness of non-medication intervention.
“The lack of congruence between how anxious a patient says he feels, his caregiver’s evaluation of that anxiety, and the use of appropriate anxiety management strategies suggests that anxiety management is inconsistent and potentially ineffective,” Frazier said.
She conducted the research with Bonnie Garvin, a professor of nursing, and Jennifer O’Brien, a nursing student, both with Ohio State; Debra Moser, of the College of Nursing at the University of Kentucky; Kyungeh An, of the Ewha Women’s University in South Korea; and Marlene Macko, of Mount Carmel Health Systems in Columbus, Ohio.
The group was supported by funding from the American Association of Critical-Care Nurses (AACN)-Sigma Theta Tau Critical Care grant; the Nellcor Puritan Bennett, Inc. AACN Mentorship grant; and the American Heart Association Student Scholar in Cardiovascular Disease and Stroke Award.