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JAMA. 1994 Dec 14;272(22):1749-56.

Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study.

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  • 1Biometrics Research Department, New York State Psychiatric Institute, NY 10032.

Abstract

OBJECTIVE:

To assess the validity and utility of PRIME-MD (Primary Care Evaluation of Mental Disorders), a new rapid procedure for diagnosing mental disorders by primary care physicians.

DESIGN:

Survey; criterion standard.

SETTING:

Four primary care clinics.

SUBJECTS:

A total of 1000 adult patients (369 selected by convenience and 631 selected by site-specific methods to avoid sampling bias) assessed by 31 primary care physicians.

MAIN OUTCOME MEASURES:

PRIME-MD diagnoses, independent diagnoses made by mental health professionals, functional status measures (Short-Form General Health Survey), disability days, health care utilization, and treatment/referral decisions.

RESULTS:

Twenty-six percent of the patients had a PRIME-MD diagnosis that met full criteria for a specific disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition. The average time required of the primary care physician to complete the PRIME-MD evaluation was 8.4 minutes. There was good agreement between PRIME-MD diagnoses and those of independent mental health professionals (for the diagnosis of any PRIME-MD disorder, kappa = 0.71; overall accuracy rate = 88%). Patients with PRIME-MD diagnoses had lower functioning, more disability days, and higher rates of health care utilization than did patients without PRIME-MD diagnoses (for all measures, P < .005). Nearly half (48%) of 287 patients with a PRIME-MD diagnosis who were somewhat or fairly well-known to their physicians had not been recognized to have that diagnosis before the PRIME-MD evaluation. A new treatment or referral was initiated for 62% of the 125 patients with a PRIME-MD diagnosis who were not already being treated.

CONCLUSION:

PRIME-MD appears to be a useful tool for identifying mental disorders in primary care practice and research.

Comment in

  • ACP J Club. 1995 May-Jun;122(3):73.
PMID:
7966923
[PubMed - indexed for MEDLINE]
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