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 language | English (US) |
|---|---|
| Pages (from-to) | 1499-1505 |
| Number of pages | 7 |
| Journal | Journal of the American Geriatrics Society |
| Volume | 46 |
| Issue number | 12 |
| DOIs | |
| State | Published - Dec 1998 |
| Externally published | Yes |
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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 journal › Article
}
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 -