Kobak K A, Taylor L H, Dottl S L, Greist J H, Jefferson J W, Burroughs D, Mantle J M, Katzelnick D J, Norton R, Henk H J, Serlin R C
Dean Foundation for Health, Research and Education, Middleton, Wis 53562, USA.
JAMA. 1997 Sep 17;278(11):905-10.
Common mental disorders are often not identified in primary care settings.
To evaluate the validity and clinical utility of a telephone-assisted computer-administered version of Primary Care Evaluation of Mental Disorders (PRIME-MD), a brief questionnaire and interview instrument designed to identify psychiatric disorders in primary care patients.
Comparison of diagnoses obtained by computer over the telephone using interactive voice response (IVR) technology vs those obtained by a trained clinician over the telephone using the Structured Clinical Interview for DSM-IV [Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition] Diagnosis (SCID). A subsample also received the clinician-administered version of PRIME-MD.
Outpatients (N=200) from 4 primary care clinics, an eating disorders clinic, an alcohol treatment facility, psychiatric outpatients, and community controls.
Interviews conducted by telephone, except for face-to-face administration of PRIME-MD, which was conducted at either the primary care clinic or a research clinic.
Prevalence rates for any psychiatric disorder were similar between diagnoses made by the computer and those made by a mental health professional using the SCID (60.0% vs 58.5%). Prevalence rates for individual diagnoses were generally similar across versions. However, primary care patients reported twice as much alcohol abuse on the computer (15.0%) as on either the SCID (7.5%) or the clinician-administered PRIME-MD (7.5%). Using the SCID as the criterion, both the computer- and clinician-administered versions of PRIME-MD demonstrated high and roughly equivalent levels of sensitivity and specificity. Overall agreement (K) for any diagnosis was 0.67 for the computer-administered PRIME-MD and 0.70 for the clinician-administered PRIME-MD.
The computer-administered PRIME-MD appears to be a valid instrument for assessing psychopathology in primary care patients. Interactive voice response technology allows for increased availability, and provides primary care physicians with information that will increase the quality of patient care without additional physician time and at minimal expense.
常见精神障碍在基层医疗环境中常常未被识别。
评估电话辅助计算机管理版的精神障碍初级保健评估工具（PRIME-MD）的有效性和临床实用性，这是一种旨在识别基层医疗患者精神障碍的简短问卷和访谈工具。
比较通过交互式语音应答（IVR）技术经电话由计算机获得的诊断结果与通过使用《精神障碍诊断与统计手册（第四版）》诊断的结构化临床访谈（SCID）经电话由训练有素的临床医生获得的诊断结果。一个子样本还接受了临床医生管理版的PRIME-MD。
来自4家基层医疗诊所、一家饮食失调诊所、一家酒精治疗机构的门诊患者、精神科门诊患者以及社区对照人群（N = 200）。
除了在基层医疗诊所或研究诊所进行面对面的PRIME-MD管理外，均通过电话进行访谈。
计算机做出的诊断与心理健康专业人员使用SCID做出的诊断中，任何精神障碍的患病率相似（60.0%对58.5%）。各个诊断的患病率在不同版本中总体相似。然而，基层医疗患者在计算机版上报告的酒精滥用情况是在SCID版（7.5%）或临床医生管理版的PRIME-MD（7.5%）上的两倍（15.0%）。以SCID作为标准，计算机管理版和临床医生管理版的PRIME-MD均表现出较高且大致相当的敏感性和特异性水平。计算机管理版PRIME-MD对于任何诊断的总体一致性（K值）为0.67，临床医生管理版PRIME-MD为0.70。
计算机管理版的PRIME-MD似乎是评估基层医疗患者精神病理学的有效工具。交互式语音应答技术提高了可及性，并为基层医疗医生提供信息，可在不增加医生工作时间且费用最低的情况下提高患者护理质量。
