Psychiatric diagnosis and intervention in older and younger patients in a primary care clinic: Effect of a screening and diagnostic instrument

Marcia Valenstein, Helen Kales, Alan Mellow, Gregory Dalack, Sara Figueroa, Kristen Lawton Barry, Frederic C. Blow

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

OBJECTIVES: To determine whether patient age is associated with psychiatric diagnosis or provider intervention in a busy primary care clinic, and, if so, whether a screening and diagnostic tool, the PRIME-MD, modifies age-related differences. DESIGN, SETTING, AND PARTICIPANTS: PRIME-MD use, psychiatric diagnosis, and provider interventions for psychiatric conditions were recorded for eligible patients attending a Veterans Affairs Medical Center primary care clinic. Data from 952 younger (< 65 years) and 1135 older patients (≥ 65 years) were analyzed to determine whether there were age- related differences in diagnosis/intervention and if use of the PRIME-MD modified these differences. INTERVENTION: Implementation of the PRIME-MD, a two-step instrument consisting of a self-administered patient questionnaire and a provider-administered structured diagnostic interview. MEASUREMENTS: Outcome measures were rates of (1) PRIME-MD use, (2) overall psychiatric diagnosis, (3) new psychiatric diagnosis, and (4) provider intervention for psychiatric conditions. RESULTS: There was no association between patient age and PRIME-MD use. Older patients were less likely to receive a psychiatric diagnosis in analyses that adjusted for 'highly positive' screening questionnaires (OR = .45; P < .001). Older patients were also less likely to receive an intervention for a psychiatric condition in analyses that adjusted for whether a psychiatric diagnosis (OR = .62, P = .015) or a new psychiatric diagnosis (OR= .36, P < .001) was made during the study visit. The PRIME-MD increased rates of diagnosis and intervention but did not alter age-related disparities. CONCLUSIONS: Decreased rates of psychiatric diagnosis and intervention in older primary care patients are of concern. Implementing the PRIME-MD will likely increase rates of diagnosis and intervention but will need to be accompanied by additional measures to eliminate age-related disparities.

Original languageEnglish (US)
Pages (from-to)1499-1505
Number of pages7
JournalJournal of the American Geriatrics Society
Volume46
Issue number12
DOIs
StatePublished - Dec 1998
Externally publishedYes

Fingerprint

Mental Disorders
Primary Health Care
Psychiatry
Veterans
Outcome Assessment (Health Care)
Interviews

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Psychiatric diagnosis and intervention in older and younger patients in a primary care clinic : Effect of a screening and diagnostic instrument. / Valenstein, Marcia; Kales, Helen; Mellow, Alan; Dalack, Gregory; Figueroa, Sara; Barry, Kristen Lawton; Blow, Frederic C.

In: Journal of the American Geriatrics Society, Vol. 46, No. 12, 12.1998, p. 1499-1505.

Research output: Contribution to journalArticle

Valenstein, Marcia ; Kales, Helen ; Mellow, Alan ; Dalack, Gregory ; Figueroa, Sara ; Barry, Kristen Lawton ; Blow, Frederic C. / Psychiatric diagnosis and intervention in older and younger patients in a primary care clinic : Effect of a screening and diagnostic instrument. In: Journal of the American Geriatrics Society. 1998 ; Vol. 46, No. 12. pp. 1499-1505.
@article{a42095e51e4e4cd7ab59713b7b4d79c6,
title = "Psychiatric diagnosis and intervention in older and younger patients in a primary care clinic: Effect of a screening and diagnostic instrument",
abstract = "OBJECTIVES: To determine whether patient age is associated with psychiatric diagnosis or provider intervention in a busy primary care clinic, and, if so, whether a screening and diagnostic tool, the PRIME-MD, modifies age-related differences. DESIGN, SETTING, AND PARTICIPANTS: PRIME-MD use, psychiatric diagnosis, and provider interventions for psychiatric conditions were recorded for eligible patients attending a Veterans Affairs Medical Center primary care clinic. Data from 952 younger (< 65 years) and 1135 older patients (≥ 65 years) were analyzed to determine whether there were age- related differences in diagnosis/intervention and if use of the PRIME-MD modified these differences. INTERVENTION: Implementation of the PRIME-MD, a two-step instrument consisting of a self-administered patient questionnaire and a provider-administered structured diagnostic interview. MEASUREMENTS: Outcome measures were rates of (1) PRIME-MD use, (2) overall psychiatric diagnosis, (3) new psychiatric diagnosis, and (4) provider intervention for psychiatric conditions. RESULTS: There was no association between patient age and PRIME-MD use. Older patients were less likely to receive a psychiatric diagnosis in analyses that adjusted for 'highly positive' screening questionnaires (OR = .45; P < .001). Older patients were also less likely to receive an intervention for a psychiatric condition in analyses that adjusted for whether a psychiatric diagnosis (OR = .62, P = .015) or a new psychiatric diagnosis (OR= .36, P < .001) was made during the study visit. The PRIME-MD increased rates of diagnosis and intervention but did not alter age-related disparities. CONCLUSIONS: Decreased rates of psychiatric diagnosis and intervention in older primary care patients are of concern. Implementing the PRIME-MD will likely increase rates of diagnosis and intervention but will need to be accompanied by additional measures to eliminate age-related disparities.",
author = "Marcia Valenstein and Helen Kales and Alan Mellow and Gregory Dalack and Sara Figueroa and Barry, {Kristen Lawton} and Blow, {Frederic C.}",
year = "1998",
month = "12",
doi = "10.1111/j.1532-5415.1998.tb01533.x",
language = "English (US)",
volume = "46",
pages = "1499--1505",
journal = "Journal of the American Geriatrics Society",
issn = "0002-8614",
publisher = "Wiley-Blackwell",
number = "12",

}

TY - JOUR

T1 - Psychiatric diagnosis and intervention in older and younger patients in a primary care clinic

T2 - Effect of a screening and diagnostic instrument

AU - Valenstein, Marcia

AU - Kales, Helen

AU - Mellow, Alan

AU - Dalack, Gregory

AU - Figueroa, Sara

AU - Barry, Kristen Lawton

AU - Blow, Frederic C.

PY - 1998/12

Y1 - 1998/12

N2 - OBJECTIVES: To determine whether patient age is associated with psychiatric diagnosis or provider intervention in a busy primary care clinic, and, if so, whether a screening and diagnostic tool, the PRIME-MD, modifies age-related differences. DESIGN, SETTING, AND PARTICIPANTS: PRIME-MD use, psychiatric diagnosis, and provider interventions for psychiatric conditions were recorded for eligible patients attending a Veterans Affairs Medical Center primary care clinic. Data from 952 younger (< 65 years) and 1135 older patients (≥ 65 years) were analyzed to determine whether there were age- related differences in diagnosis/intervention and if use of the PRIME-MD modified these differences. INTERVENTION: Implementation of the PRIME-MD, a two-step instrument consisting of a self-administered patient questionnaire and a provider-administered structured diagnostic interview. MEASUREMENTS: Outcome measures were rates of (1) PRIME-MD use, (2) overall psychiatric diagnosis, (3) new psychiatric diagnosis, and (4) provider intervention for psychiatric conditions. RESULTS: There was no association between patient age and PRIME-MD use. Older patients were less likely to receive a psychiatric diagnosis in analyses that adjusted for 'highly positive' screening questionnaires (OR = .45; P < .001). Older patients were also less likely to receive an intervention for a psychiatric condition in analyses that adjusted for whether a psychiatric diagnosis (OR = .62, P = .015) or a new psychiatric diagnosis (OR= .36, P < .001) was made during the study visit. The PRIME-MD increased rates of diagnosis and intervention but did not alter age-related disparities. CONCLUSIONS: Decreased rates of psychiatric diagnosis and intervention in older primary care patients are of concern. Implementing the PRIME-MD will likely increase rates of diagnosis and intervention but will need to be accompanied by additional measures to eliminate age-related disparities.

AB - OBJECTIVES: To determine whether patient age is associated with psychiatric diagnosis or provider intervention in a busy primary care clinic, and, if so, whether a screening and diagnostic tool, the PRIME-MD, modifies age-related differences. DESIGN, SETTING, AND PARTICIPANTS: PRIME-MD use, psychiatric diagnosis, and provider interventions for psychiatric conditions were recorded for eligible patients attending a Veterans Affairs Medical Center primary care clinic. Data from 952 younger (< 65 years) and 1135 older patients (≥ 65 years) were analyzed to determine whether there were age- related differences in diagnosis/intervention and if use of the PRIME-MD modified these differences. INTERVENTION: Implementation of the PRIME-MD, a two-step instrument consisting of a self-administered patient questionnaire and a provider-administered structured diagnostic interview. MEASUREMENTS: Outcome measures were rates of (1) PRIME-MD use, (2) overall psychiatric diagnosis, (3) new psychiatric diagnosis, and (4) provider intervention for psychiatric conditions. RESULTS: There was no association between patient age and PRIME-MD use. Older patients were less likely to receive a psychiatric diagnosis in analyses that adjusted for 'highly positive' screening questionnaires (OR = .45; P < .001). Older patients were also less likely to receive an intervention for a psychiatric condition in analyses that adjusted for whether a psychiatric diagnosis (OR = .62, P = .015) or a new psychiatric diagnosis (OR= .36, P < .001) was made during the study visit. The PRIME-MD increased rates of diagnosis and intervention but did not alter age-related disparities. CONCLUSIONS: Decreased rates of psychiatric diagnosis and intervention in older primary care patients are of concern. Implementing the PRIME-MD will likely increase rates of diagnosis and intervention but will need to be accompanied by additional measures to eliminate age-related disparities.

UR - http://www.scopus.com/inward/record.url?scp=0031741396&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0031741396&partnerID=8YFLogxK

U2 - 10.1111/j.1532-5415.1998.tb01533.x

DO - 10.1111/j.1532-5415.1998.tb01533.x

M3 - Article

C2 - 9848809

AN - SCOPUS:0031741396

VL - 46

SP - 1499

EP - 1505

JO - Journal of the American Geriatrics Society

JF - Journal of the American Geriatrics Society

SN - 0002-8614

IS - 12

ER -