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. 1997 Nov;12(11):679-85.
doi: 10.1046/j.1525-1497.1997.07141.x.

Screening for psychiatric illness with a combined screening and diagnostic instrument

M Valenstein  1 , G Dalack, F Blow, S Figueroa, C Standiford, A Douglass
Affiliations

Screening for psychiatric illness with a combined screening and diagnostic instrument

M Valenstein et al. J Gen Intern Med. 1997 Nov.

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 nonselected providers and customary visit lengths. This level of support should be achievable in most clinical settings.

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Figures

None
Figure Support conditions and CEG use. After adjustment for study week and patient age group, there was a trend for RN support to result in significantly more CEG use than NCSS ( p = .55). The prompt condition resulted in significantly more CEG use than either NCSS or RN support (p < .001, and p < .05, respectively).
None
Figure Percentage of CEG use by study week.
See this image and copyright information in PMC

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