Valenstein M, Kales H, Mellow A, Dalack G, Figueroa S, Lawton Barry K, Blow F C
Serious Mental Illness Treatment Research and Evaluation Center, Department of Psychiatry, University of Michigan, Ann Arbor 48113-0170, USA.
J Am Geriatr Soc. 1998 Dec;46(12):1499-505. doi: 10.1111/j.1532-5415.1998.tb01533.x.
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 (> 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.
Implementation of the PRIME-MD, a two-step instrument consisting of a self-administered patient questionnaire and a provider-administered structured diagnostic interview.
Outcome measures were rates of (1) PRIME-MD use, (2) overall psychiatric diagnosis, (3) new psychiatric diagnosis, and (4) provider intervention for psychiatric conditions.
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.
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.
确定在一家繁忙的初级保健诊所中，患者年龄是否与精神科诊断或医生干预相关；如果存在关联，一种筛查和诊断工具即PRIME-MD是否能改变与年龄相关的差异。
设计、场所和参与者：记录了在退伍军人事务医疗中心初级保健诊所就诊的符合条件患者使用PRIME-MD的情况、精神科诊断以及针对精神疾病的医生干预措施。分析了952名较年轻患者（<65岁）和1135名老年患者（≥65岁）的数据，以确定在诊断/干预方面是否存在与年龄相关的差异，以及PRIME-MD的使用是否改变了这些差异。
采用PRIME-MD，这是一种两步式工具，包括患者自行填写的问卷和医生进行的结构化诊断访谈。
结果指标包括(1)PRIME-MD的使用率、(2)总体精神科诊断率、(3)新的精神科诊断率以及(4)针对精神疾病的医生干预率。
患者年龄与PRIME-MD的使用之间无关联。在对“高度阳性”筛查问卷进行校正的分析中，老年患者获得精神科诊断的可能性较小（OR = 0.45；P<0.001）。在对研究就诊期间是否做出精神科诊断（OR = 0.62，P = 0.015）或新的精神科诊断（OR = 0.36，P<0.001）进行校正的分析中，老年患者接受精神疾病干预的可能性也较小。PRIME-MD提高了诊断率和干预率，但并未改变与年龄相关的差异。
初级保健老年患者中精神科诊断和干预率降低令人担忧。实施PRIME-MD可能会提高诊断率和干预率，但还需要采取其他措施来消除与年龄相关的差异。
