Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study.
Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study.
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DOI：
10.1001/jama.1994.03520220043029
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发表时间：
1994-12
期刊：
影响因子：
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通讯作者：
R. Spitzer;Janet B W Williams;K. Kroenke;M. Linzer;F. deGruy;S. Hahn;David S. Brody;Jeffrey G. Johnson
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文献类型：
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作者：
R. Spitzer;Janet B W Williams;K. Kroenke;M. Linzer;F. deGruy;S. Hahn;David S. Brody;Jeffrey G. Johnson
目的评价PRIME-MD(初级护理精神障碍评估)的效度和实用性，为临床医师快速诊断精神障碍提供依据。设计勘察；规范标准。设置四个初级保健诊所。研究对象：由31名初级保健医生对1000名成人患者(369名通过方便选择，631名通过特定地点的方法选择以避免抽样偏差)进行评估。主要结果指标Prime-MD诊断、精神卫生专业人员的独立诊断、功能状态测量(简写为General Health Survey)、残疾天数、卫生保健利用情况以及治疗/转诊决定。结果26%的患者PRIME-MD诊断符合《精神障碍诊断与统计手册》第三版修订版中对特定障碍的完整标准。初级保健医生完成Prime-MD评估所需的平均时间为8.4分钟。Prime-MD诊断与独立精神卫生专业人员的诊断有很好的一致性(对于任何Prime-MD障碍的诊断，kappa=0.71；总体准确率=88%)。与未诊断Prime-MD的患者相比，诊断为Prime-MD的患者功能较差，残疾天数较多，卫生保健利用率较高(对于所有指标，P<；.005)。在287名被诊断为Prime-MD的患者中，近一半(48%)的医生多少或相当熟悉他们的医生，但在Prime-MD评估之前，他们没有被承认患有这种诊断。在125名被诊断为Prime-MD的患者中，62%的人开始了新的治疗或转诊，这些患者还没有接受治疗。结论PRIME-MD在初级保健实践和研究中是一种识别精神障碍的有用工具。
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.