Validation and utility of a self-report version of PRIME-MD - The PHQ primary care study
Validation and utility of a self-report version of PRIME-MD - The PHQ primary care study
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DOI：
10.1001/jama.282.18.1737
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发表时间：
1999-11-10
影响因子：
120.7
通讯作者：
Williams, JBW
中科院分区：
文献类型：
--
作者：
Spitzer, RL;Kroenke, K;Williams, JBW
PRIME-MD是一种筛查工具，但其使用时间限制了其在临床上的应用。目的确定自编的PRIME-MD患者健康问卷(PHQ)对初级保健中精神疾病的诊断是否具有与最初临床医生使用的PRIME-MD相当的效度和效用。设计标准研究于1997年5月至1998年11月在美国设立了8个初级保健诊所。共3000名成人患者(通过现场特定方法选择)由62名初级保健医生(21名全科内科医生，41名家庭医生)进行评估，585例患者在完成PHQ后48小时内与精神卫生专业人员进行了面谈。主要结果衡量患者健康问卷诊断与精神卫生专业人员独立诊断的比较；结果3000人中的825人(28%)和585人中的170人(29%)被诊断为PHQ。PHQ诊断与独立精神卫生专业人员的诊断有很好的一致性(对于任何一种或多种PHQ障碍的诊断，kappa=0.65；总体准确率，85%；敏感度，75%；特异度，90%)，类似于最初的Prime-MD。有PHQ诊断的患者比无PHQ诊断的患者有更多的功能障碍、残疾天数和医疗保健利用(对于所有组的主要影响，P
Context The Primary Care Evaluation of Mental Disorders (PRIME-MD) was developed as a screening instrument but its administration time has limited its clinical usefulness.Objective To determine if the self-administered PRIME-MD Patient Health Questionnaire (PHQ) has validity and utility for diagnosing mental disorders in primary care comparable to the original clinician-administered PRIME-MD.Design Criterion standard study undertaken between May 1997 and November 1998.Setting Eight primary care clinics in the United States.Participants Of a total of 3000 adult patients (selected by site-specific methods to avoid sampling bias) assessed by 62 primary care physicians (21 general internal medicine, 41 family practice), 585 patients had an interview with a mental health professional within 48 hours of completing the PHQ.Main Outcome Measures Patient Health Questionnaire diagnoses compared with independent diagnoses made by mental health professionals; functional status measures; disability days; health care use; and treatment/referral decisions.Results A total of 825 (28%) of the 3000 individuals and 170 (29%) of the 585 had a PHQ diagnosis. There was good agreement between PHQ diagnoses and those of independent mental health professionals (for the diagnosis of any 1 or more PHQ disorder, kappa = 0.65; overall accuracy, 85%; sensitivity, 75%; specificity, 90%), similar to the original PRIME-MD. Patients with PHQ diagnoses had more functional impairment, disability days, and health care use than did patients without PHQ diagnoses (for all group main effects, P