Psychiatric diagnosis and intervention in older and younger patients in a primary care clinic: effect of a screening and diagnostic instrument.
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.
Valenstein
M
M
Serious Mental Illness Treatment Research and Evaluation Center, Department of Psychiatry, University of Michigan, Ann Arbor 48113-0170, USA.
Kales
H
H
Mellow
A
A
Dalack
G
G
Figueroa
S
S
Lawton Barry
K
K
Blow
F C
FC
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*