P&S Journal: Spring 1995, Vol.15, No.2
Research & Reports
PRIME-MD 1000 Study
Studies have suggested that today's physicians in office settings fail to diagnose and treat up to 50 percent of patients suffering from depression and other common mental disorders. But a psychiatrist, a psychiatric social worker, and a clinical psychologist, all three Columbia faculty members, and five primary care physicians have introduced a new procedure designed to help remedy this situation.
Called Primary Care Evaluation of Mental Disorders (PRIME-MD), the system consists of a one-page patient questionnaire and a 12-page clinical evaluation guide for physicians to assess four groups of mental disorders (mood, anxiety, alcohol, and somatoform) and eating disorders. The questionnaire consists of 26 yes or no questions about symptoms and signs present during the past month and one question about the patient's overall health. Based on the questionnaire answers, physicians determine which, if any, of the evaluation guide diagnostic modules should be used.
"We wanted to make sure that with this simple system we came up with more or less the same prevalence of mental disorders that other people who would use much more extensive, time-consuming procedures," says Dr. Robert Spitzer, professor of psychiatry at the New York State Psychiatric Institute. "In fact, we did."
Dr. Spitzer and colleagues who helped develop the system assessed the validity of the procedure in a study reported in a December 1994 issue of the Journal of the American Medical Association. More than one-fourth of the 1,000 patients surveyed at four PRIME-MD evaluation sites from January 1992 to March 1993 met criteria for a specific mental disorder.
Patients in the study responded positively to the questions asked by their primary care physicians, Dr. Spitzer says. Evaluations took an average of eight minutes. "The vast majority thought it was information of value to their physician. In fact, some spontaneously told us that they were surprised and delighted that their physician took the time to discuss these things with them."
Mental health professionals conducted independent telephone interviews with patients on the same day as their clinical evaluation to rate the accuracy of the diagnosis.
"The agreement between those diagnoses and the diagnoses made by the primary care physicians was substantial, about as good as you find in psychiatry," Dr. Spitzer says.
Pfizer Inc., which funded the study, conducts training sessions for primary care physicians nationwide to explain PRIME-MD. Sessions typically include a lecture about the pharmacology of depression.
"The response seems to be quite positive, although we don't actually know in a systematic way how many of those people take the procedure from the meeting and actually use it," Dr. Spitzer says. "Our goal is not necessarily that they use the actual procedure. Once they've given it 10 or 15 times on a regular basis, we understand that many of them just incorporate the questions into their own assessment, and they don't need to actually use the paper version."
Dr. Spitzer says the study is a good example of a positive collaboration between psychiatry and primary care to meet patient needs. "It demonstrates that we're not in a competitive situation. Psychiatrists don't have to worry about having fewer patients. In fact, there was actually an increase in referrals to mental health specialists, so there are plenty of patients out there for everybody."
Other faculty who participated in the study were Dr. Janet Williams, professor of clinical psychiatric social work, and Dr. Jeffrey Johnson, assistant professor of clinical psychology. Other clinical sites were Uniformed Services University; New England Medical Center in Boston; University of South Alabama College of Medicine in Mobile, Ala.; Albert Einstein College of Medicine in the Bronx; and Mercy Catholic Medical Center in Darby, Pa.