title: Psychiatric diagnosis and intervention in older and younger patients in a primary care clinic: effect of a screening and diagnostic instrument.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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 (> or =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.
  
  
  METHODS
  Implementation of the PRIME-MD, a two-step instrument consisting of a self-administered patient questionnaire and a provider-administered structured diagnostic interview.
  
  
  METHODS
  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.
authors.affiliation: Serious Mental Illness Treatment Research and Evaluation Center, Department of Psychiatry, University of Michigan, Ann Arbor 48113-0170, USA.
authors.forename: M
authors.initials: M
authors.lastname: Valenstein
authors.forename: H
authors.initials: H
authors.lastname: Kales
authors.forename: A
authors.initials: A
authors.lastname: Mellow
authors.forename: G
authors.initials: G
authors.lastname: Dalack
authors.forename: S
authors.initials: S
authors.lastname: Figueroa
authors.forename: K
authors.initials: K
authors.lastname: Lawton Barry
authors.forename: F C
authors.initials: FC
authors.lastname: Blow
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003704:Dementia / Q000145:classification / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D015577:Geriatric Assessment / Q000706:statistics & numerical data*; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000145:classification / Q000175:diagnosis* / Q000628:therapy; D008824:Michigan; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D010348:Patient Care Team; D010552:Personality Assessment / Q000706:statistics & numerical data*; D011320:Primary Health Care; D011446:Prospective Studies; D011594:Psychometrics; D015203:Reproducibility of Results; D014728:Veterans / Q000523:psychology*