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ARTICLE |

Utility of a New Procedure for Diagnosing Mental Disorders in Primary Care:  The PRIME-MD 1000 Study

Robert L. Spitzer, MD; Janet B. W. Williams, DSW; Kurt Kroenke, MD; Mark Linzer, MD; Frank Verloin deGruy III, MD; Steven R. Hahn, MD; David Brody, MD; Jeffrey G. Johnson, PhD
JAMA. 1994;272(22):1749-1756. doi:10.1001/jama.1994.03520220043029.
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Objective.  —To assess the validity and utility of PRIME-MD (Primary Care Evaluation of Mental Disorders), a new rapid procedure for diagnosing mental disorders by primary care physicians.

Design.  —Survey; criterion standard.

Setting.  —Four primary care clinics.

Subjects.  —A total of 1000 adult patients (369 selected by convenience and 631 selected by site-specific methods to avoid sampling bias) assessed by 31 primary care physicians.

Main Outcome Measures.  —PRIME-MD diagnoses, independent diagnoses made by mental health professionals, functional status measures (Short-Form General Health Survey), disability days, health care utilization, and treatment/ referral decisions.

Results.  —Twenty-six percent of the patients had a PRIME-MD diagnosis that met full criteria for a specific disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition. The average time required of the primary care physician to complete the PRIME-MD evaluation was 8.4 minutes. There was good agreement between PRIME-MD diagnoses and those of independent mental health professionals (for the diagnosis of any PRIME-MD disorder, κ=0.71; overall accuracy rate=88%). Patients with PRIME-MD diagnoses had lower functioning, more disability days, and higher rates of health care utilization than did patients without PRIME-MD diagnoses (for all measures, P<.005). Nearly half (48%) of 287 patients with a PRIME-MD diagnosis who were somewhat or fairly well-known to their physicians had not been recognized to have that diagnosis before the PRIME-MD evaluation. A new treatment or referral was initiated for 62% of the 125 patients with a PRIME-MD diagnosis who were not already being treated.

Conclusion.  —PRIME-MD appears to be a useful tool for identifying mental disorders in primary care practice and research.(JAMA. 1994;272:1749-1756)

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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