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Screening for psychiatric Illness with a combined screening and diagnostic instrument

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Abstract

Objective

To determine 1) if the PRIME-MD, a two-step screening and diagnostic instrument for psychiatric disorders, increases diagnosis and intervention when actively implemented in a busy general medicine clinic, and 2) the type of staff support required to achieve sufficient implementation to realize gains in diagnosis and treatment.

Design

We introduced the PRIME-MD into a large general medicine clinic with repeated rotation of four support conditions for implementation: (1) no support, (2) nonclinical staff support (NCSS), (3) nursing staff (RN) support, and (4) a written “Prompt” condition.

Setting and Patients

Patients (N=2,263) attending a general medicine clinic at a Veterans Affairs Medical Center.

Measurements and Main Results

Outcome measures were (1) PRIME-MD questionnaire and interview use, (2) overall psychiatric diagnosis, (3) new psychiatric diagnosis, and (4) provider intervention for psychiatric conditions. The NCSS, RN support, and prompt conditions resulted in similar rates of questionnaire use but significantly different rates of structured interview use. The NCSS condition was associated with significant increases in new diagnosis, and the RN support and Prompt condition were associated with significant increases in new diagnosis and intervention compared with no support.

Conclusions

Nursing staff support resulted in sufficient PRIME-MD implementation to achieve gains in both new diagnosis and provider intervention compared with no support. These gains occurred in a busy primary care clinic with non-selected providers and customary visit lengths. This level of support should be achievable in most clinical settings.

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Author information

Authors and Affiliations

  1. Psychiatry Service, Veterans Affairs Medical Center, Ann Arbor, Mich.

    Marcia Valenstein MD, Gregory Dalack MD & Alan Douglass MD

  2. SMITREC, Health Services Research and Development, Veterans Affairs Medical Center, Ann Arbor, Mich.

    Marcia Valenstein MD & Frederic Blow PhD

  3. Department of Psychiatry, University of Michigan, Ann Arbor, Mich.

    Marcia Valenstein MD, Gregory Dalack MD, Frederic Blow PhD, Sara Figueroa MD & Alan Douglass MD

  4. Department of Internal Medicine, University of Michigan, Ann Arbor, Mich.

    Connie Standiford MD

Authors
  1. Marcia Valenstein MD
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  2. Gregory Dalack MD
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  3. Frederic Blow PhD
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  4. Sara Figueroa MD
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  5. Connie Standiford MD
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  6. Alan Douglass MD
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Additional information

Supported by an unrestricted educational grant from the Pfizer Corporation.

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Valenstein, M., Dalack, G., Blow, F. et al. Screening for psychiatric Illness with a combined screening and diagnostic instrument. J GEN INTERN MED 12, 679–685 (1997). https://doi.org/10.1046/j.1525-1497.1997.07141.x

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  • DOI: https://doi.org/10.1046/j.1525-1497.1997.07141.x

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