Reifler D R, Kessler H S, Bernhard E J, Leon A C, Martin G J
Division of General Internal Medicine, Northwestern University Medical School, Chicago, IL, USA.
Arch Intern Med. 1996;156(22):2593-9.
Mental health concerns are common in primary care patients and are often inadequately addressed by primary care physicians.
To assess the impact of screening for mental disorders in internal medicine patients.
Randomly selected patients (n = 358) visiting physicians in 2 firms of an urban academic internal medicine clinic were screened for mental disorders using the 16-item Symptom-Driven Diagnostic System for Primary Care (Upjohn Co, Kalamazoo, Mich) first-stage screening questionnaire. In the experimental firm, physicians received the screening results and then administered second-stage diagnostic modules. In the control firm, physicians were not notified of the results of the screening questionnaire. Baseline and 3-month function were assessed using the SF-36 Health Survey, the Zung Self-Rating Depression Scale, and the Sheehan Patient-Rated Anxiety Scale. Patient satisfaction and health care utilization were also assessed by questionnaire at baseline and after 3 months.
Patients screening positively for any mental disorder (n = 238, 66.5%) had markedly lower baseline functional status than those screening negatively (P < .05 on all 8 SF-36 Health Survey subscales) and more total (+/- SD) outpatient visits over 3 months (4.5 +/- 5.5 vs 2.5 +/- 2.6 visits, P = .001). Among patients who screened positively, functional outcomes and patient satisfaction were similar in experimental and control groups; mean utilization (+/- SD) was lower in the experimental group (3.7 +/- 3.9 vs 5.3 +/- 6.7 total outpatient visits at 3 months, P = .06; 0.9 +/- 1.5 vs 2.1 +/- 3.7 visits to non-mental health specialists, P = .003; 0.2 +/- 0.5 vs 0.4 +/- 0.9 x-ray films per patient, P = .01). The follow-up response rate was 286 (79.9%) of 358 patients.
The 16-item first-stage Symptom-Driven Diagnostic System for Primary Care screening questionnaire for mental disorders can identify primary care patients who are at risk for lower functional status and higher utilization. Use of the Symptom-Driven Diagnostic System for Primary Care second-stage diagnostic modules in patients who screened positively for mental disorders was associated with lower utilization rates but had no impact on functional outcome or patient satisfaction after 3 months.
心理健康问题在初级保健患者中很常见，而初级保健医生往往对此处理不足。
评估对内科患者进行精神障碍筛查的影响。
在一家城市学术性内科诊所的两家机构中，随机选择就诊的患者（n = 358），使用16项初级保健症状驱动诊断系统（美国密歇根州卡拉马祖的Upjohn公司）第一阶段筛查问卷对其进行精神障碍筛查。在试验机构中，医生收到筛查结果，然后进行第二阶段诊断模块。在对照机构中，未告知医生筛查问卷的结果。使用SF-36健康调查、zung自评抑郁量表和希恩患者自评焦虑量表评估基线和3个月时的功能。在基线和3个月后还通过问卷调查评估患者满意度和医疗保健利用率。
任何精神障碍筛查呈阳性的患者（n = 238，66.5%）的基线功能状态明显低于筛查呈阴性的患者（所有8个SF-36健康调查子量表上P <.05），并且在3个月内的门诊就诊总数（+/-标准差）更多（4.5 +/- 5.5次 vs 2.5 +/- 2.6次就诊，P =.001）。在筛查呈阳性的患者中，试验组和对照组的功能结局和患者满意度相似；试验组的平均利用率（+/-标准差）较低（3个月时门诊就诊总数为3.7 +/- 3.9次 vs 5.3 +/- 6.7次，P =.06；非精神科专科医生就诊次数为0.9 +/- 1.5次 vs 2.1 +/- 3.7次，P =.003；每位患者的X光片数量为0.2 +/- 0.5张 vs 0.4 +/- 0.9张，P =.01）。358名患者中的286名（79.9%）进行了随访。
16项初级保健精神障碍症状驱动诊断系统第一阶段筛查问卷可识别功能状态较低和利用率较高风险的初级保健患者。对精神障碍筛查呈阳性的患者使用初级保健症状驱动诊断系统第二阶段诊断模块与较低的利用率相关，但对3个月后的功能结局或患者满意度没有影响。
