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

Abstract

<h3>Objective.</h3> —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. <h3>Design.</h3> —Survey; criterion standard. <h3>Setting.</h3> —Four primary care clinics. <h3>Subjects.</h3> —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. <h3>Main Outcome Measures.</h3> —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. <h3>Results.</h3> —Twenty-six percent of the patients had a PRIME-MD diagnosis that met full criteria for a specific disorder according to the<i>Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition</i>. 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, κ=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,<i>P</i>&lt;.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. <h3>Conclusion.</h3> —PRIME-MD appears to be a useful tool for identifying mental disorders in primary care practice and research. (<i>JAMA</i>. 1994;272:1749-1756)

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