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‐related differences. DESIGN, SETTING, AND PARTICIPANTS: PRIME‐MD use, psychiatric diagnosis, and provider interventions for psychiatric conditions were recorded for eligible patients attending a Veterans Affairs Medical Center primary care clinic. Data from 952 younger (< 65 years) and 1135 older patients (>65 years) were analyzed to determine whether there were age‐related differences in diagnosis/intervention and if use of the PRIME‐MD modified these differences. INTERVENTION : Implementation of the PRIME‐MD, a two‐step instrument consisting of a self‐administered patient questionnaire and a provider‐administered structured diagnostic interview. MEASUREMENTS : Outcome measures were rates of (1) PRIME‐MD use, (2) overall psychiatric diagnosis, (3) new psychiatric diagnosis, and (4) provider intervention for psychiatric conditions. RESULTS : There was no association between patient age and PRIME‐MD use. Older 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 for a psychiatric condition in analyses that adjusted for whether a psychiatric 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 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. J Am Geriatr Soc 46:1499–1505, 1998 .