Assessment Tools for General Health Care Settings: PRIME-MD, OARS, and SF-36

Managed care increases the demand for efficient and accountable medical care and emphasizes the role of the primary care system. In a managed care network, health care providers are challenged to identify accurately and rapidly a variety of health problems. At the same time there is growing recognition of the need to go beyond individual symptoms to identify potential comorbid problems, levels of client functioning, and quality-of-life issues (Schulberg, 1995). These problems occur within the context of growing evidence that mental health problems tend not to be identified in the primary care system (Schulberg, 1991), although people with mental health problems are more likely to be treated in the general health care system than by specialized mental health services (Barker et al., 1992). Mental health problems like depression can also contribute to serious impairment in functioning (Wells et al., 1989; Williams et al., 1995). In the demand for greater accountability, social workers have not historically played a prominent role in the outcomes research movement. Increased concerns about patient outcomes and costs now act as major incentives for all health care professionals to move in this direction. To meet these challenges tools for assessment and outcome evaluation are being designed or upgraded for use in general medical care. These tools are designed to enable health professionals to gain a more accurate picture of the mental health, functional ability, and quality of life of individuals. This article describes three tools that can be used by social workers and other health professionals for that purpose: the Primary Care Evaluation of Mental Health Disorders (PRIME-MD), the Older Americans Resources and Services Questionnaire (OARS), and the Short Form 36 (SF-36) Health-Related Quality-of-Life Measure. PRIMARY CARE EVALUATION OF MENTAL HEALTH DISORDERS (PRIME-MD) PRIME-MD was designed to diagnose mental health problems in the primary care sector. It targets five basic areas common in the general population and primary care: mood, anxiety, somatoform, and eating disorders and alcohol abuse. The instrument consists of two basic components: a one-page questionnaire (PQ) completed by the patient before seeing the health providers and a 12-page clinician evaluation guide (CEG). The PQ consists of 26 questions regarding physical symptoms and mental health problems. The CEG is a structured interview form that the clinician uses to follow up on positive responses on the PQ. The instrument can be used flexibly. It can be incorporated into routine protocol or as a diagnostic tool with people in whom mental health problems are suspected or who pose management problems. The clinician can decide to follow up with only the elements of the CEG triggered by the PQ or to pursue other areas as well. Using the five basic categories, the clinician can determine the presence or absence of 18 diagnostic categories that correspond to nine specific DSM-IV (American Psychiatric Association, 1994) categories: major depression, partial remission or reoccurrence of major depressive disorder, dysthymia, panic disorder, generalized anxiety disorder, bulimia nervosa, multisomatoform disorder, somatoform pain disorder, and hypochondriasis. Another six are viewed as subthreshold because they meet fewer criteria than are required for DSM-IV diagnosis: anxiety disorders not other specified (NOS), somatoform disorder NOS, eating disorder NOS, minor depressive disorder, and binge eating disorder; alcohol dependence is also included in this group because further information is typically required. PRIME-MD has proved an appropriate screening tool for adults ranging from 18 to 91, for both men and women, and for those with different educational levels and belonging to different racial and ethnic groups. The instrument compares favorably with diagnostic interviews by trained mental health providers, especially for the two important problems of major depression and panic disorder. …