Psychiatric Diagnosis and Intervention in Older and Younger Patients in a Primary Care Clinic: Effect of a Screening and Diagnostic Instrument

Valenstein, Marcia; Kales, Helen C.; Mellow, Alan M.; Dalack, Gregory W.; Figueroa, Sara; Barry, Kristen L.; Blow, Frederic C.

doi:10.1111/j.1532-5415.1998.tb01533.x

Cited by 25 publications

(11 citation statements)

References 57 publications

(77 reference statements)

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“…These studies showed that physician notification of depression status resulted in slight improvements in quality of depression care, but no replicable effects on improved depression outcomes [16]. Several later studies built on these initial failures to attempt to enhance depression outcomes by randomizing depressed primary care patients into those whose physicians were notified about a major depression diagnosis and provided with an algorithm of recommended depression care vs. those allowed to remain in usual care [17,18]. Again, no replicable effects on patient-level outcomes were demonstrated.…”

mentioning

confidence: 99%

Collaborative depression care: history, evolution and ways to enhance dissemination and sustainability

Katon

Unützer

Wells

et al. 2010

General Hospital Psychiatry

262

189

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Objective To describe the history and evolution of the collaborative depression care model and new research aimed at enhancing dissemination. Method Four keynote speakers from the 2009 NIMH Annual Mental Health Services Meeting collaborated in this article in order to describe the history and evolution of collaborative depression care, adaptation of collaborative care to new populations and medical settings, and optimal ways to enhance dissemination of this model. Results Extensive evidence across 37 randomized trials has shown the effectiveness of collaborative care vs. usual primary care in enhancing quality of depression care and in improving depressive outcomes for up to 2 to 5 years. Collaborative care is currently being disseminated in large health care organizations such as the Veterans Administration and Kaiser Permanente, as well as in fee-for-services systems and federally funded clinic systems of care in multiple states. New adaptations of collaborative care are being tested in pediatric and ob-gyn populations as well as in populations of patients with multiple comorbid medical illnesses. New NIMH-funded research is also testing community-based participatory research approaches to collaborative care to attempt to decrease disparities of care in underserved minority populations. Conclusion Collaborative depression care has extensive research supporting the effectiveness of this model. New research and demonstration projects have focused on adapting this model to new populations and medical settings and on studying ways to optimally disseminate this approach to care, including developing financial models to incentivize dissemination and partnerships with community populations to enhance sustainability and to decrease disparities in quality of mental health care.

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mentioning

confidence: 99%

Collaborative depression care: history, evolution and ways to enhance dissemination and sustainability

Katon

Unützer

Wells

et al. 2010

General Hospital Psychiatry

262

189

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“…“Any depressive-anxiety-alcohol disorder” was a composite category created if women were classified as having at least one of the four psychiatric diagnoses. The PRIME-MD has been used with the elderly including those with cognitive impairment 26–28. Screening instruments for bipolar disorders, thought disorders, personality disorders, or other substance abuse disorders were not used.…”

Section: Methodsmentioning

confidence: 99%

Psychiatric Disorders and Cognitive Dysfunction Among Older, Postmenopausal Women: Results From the Women's Health Initiative Memory Study

Colenda

Legault²,

Rapp

et al. 2010

The American Journal of Geriatric Psychiatry

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Objective To estimate the frequency of depressive symptoms and selected psychiatric disorders in the Women’s Health Initiative Memory Study (WHIMS) cohort and related them to cognitive syndromes. Design WHIMS was a randomized, double-blinded, placebo-controlled prevention clinical trial examining whether opposed and unopposed hormone therapy reduced the risk of dementia in healthy postmenopausal women. Participants scoring below a designated cutpoint on a cognitive screener received a comprehensive neuropsychiatric workup and adjudicated outcome of no cognitive impairment, mild cognitive impairment, or probable dementia. Participants Seven thousand four hundred seventy-nine WHIMS participants between age 65 and 79 years and free of dementia at the time of enrollment in WHIMS. Five hundred twenty-one unique participants contributed complete data required for these analyses. Measures Depressive symptoms were measured with the 15-item Geriatric Depression Scale and the presence of selected psychiatric disorders (major depression, generalized anxiety, and panic and alcohol abuse) was made using the PRIME-MD. Results The 18% of women had at least one psychiatric disorder with depression being the most common (16%) followed by general anxiety or panic (6%) and alcohol abuse (1%). Depression and the presence of a psychiatric disorder were associated with impaired cognitive status. Participants having a psychiatric disorder were more than twice as likely to be diagnosed with cognitive impairment as those with no psychiatric disorder (odds ratio = 2.06, 95% confidence interval = 1.17–3.60). Older age, white race, and diabetes were also associated with cognitive impairment. Conclusion The frequency of a psychiatric disorder is associated with poorer cognitive functioning among older women enrolled in WHIMS. That approximately one in five women had a probable psychiatric disorder, most typically depression, highlights the need for greater detection and treatment efforts in this population.

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“…The paper “Psychiatric Diagnosis and Intervention in Older and Younger Patients in a Primary Care Clinic: Effect of a Screening and Diagnostic Instrument,” by Valenstein, Kales, and co‐workers, 1 reports findings in regard to the use of a standardized approach to screening for psychiatric symptoms and diagnosing mental disorders in a Veterans Administration primary care clinic. The screening instrument, the PRIME‐MD, 2 was designed specifically to probe for mood‐, anxiety‐, somatoform‐, eating‐, and alcohol‐related disorders in primary care settings.…”

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confidence: 99%

“…copies (Net Press Run), 10,450. (b) Paid and/or requested circulation; (1) Sales through dealers and carriers, street vendors and counter sales (not mailed), 541; (2) Paid or Requested mail subscriptions (include Advertisers Proof Copies/Exchange Copies), 8,509. (c) Total paid and/or requested circulation (sum of 15b(1) and 15b(2)), 9,050.…”

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confidence: 99%

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What Should We Do About Undertreatment of Late Life Psychiatric Disorders in Primary Care?

Katz

1998

J American Geriatrics Society

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Psychiatric Diagnosis and Intervention in Older and Younger Patients in a Primary Care Clinic: Effect of a Screening and Diagnostic Instrument

Abstract: 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.

Cited by 25 publications

References 57 publications

Collaborative depression care: history, evolution and ways to enhance dissemination and sustainability

Collaborative depression care: history, evolution and ways to enhance dissemination and sustainability

Psychiatric Disorders and Cognitive Dysfunction Among Older, Postmenopausal Women: Results From the Women's Health Initiative Memory Study

What Should We Do About Undertreatment of Late Life Psychiatric Disorders in Primary Care?

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