Psychiatric diagnosis and intervention in older and younger patients in a primary care clinic: Effect of a screening and diagnostic instrument

OBJECTIVES: 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-rel ated differences. DESIGN, SETTING, AND PARTICIPANTS: PRIME-MD use, psychiatric diagnosis, and provider interventions for psychiatric conditions were recorded for eligib le patients attending a Veterans Affairs Medical Center primary care clinic . Data from 952 younger (< 65 years) and 1135 older patients (greater than or equal to 65 years) were analyzed to determine whether there were age-rel ated differences in diagnosis/intervention and if use of the PRIME-MD modif ied these differences. INTERVENTION: Implementation of the PRIME-MD, a two-step instrument consist ing of a self-administered patient questionnaire and a provider-administere d structured diagnostic interview. MEASUREMENTS: Outcome measures were rate s of (1) PRIME-MD use, (2) overall psychiatric diagnosis, (3) new psychiatr ic diagnosis, and (4) provider intervention for psychiatric conditions. RESULTS: There was no association between patient age and PRIME-MD use. Old er 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 fo r a psychiatric condition in analyses that adjusted for whether a psychiatr ic 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. CONCLUSIONS: Decreased rates of psychiatric diagnosis and intervention in o lder primary care patients are of concern. Implementing the PRIME-MD will l ikely increase rates of diagnosis and intervention but will need to be acco mpanied by additional measures to eliminate age-related disparities.