Blevins N, Dimoulas E, Frank R; AcademyHealth. Meeting (2004 : San Diego, Calif.).
Abstr AcademyHealth Meet. 2004; 21: abstract no. 1701.
Florida Center for Medicaid and the Uninsured, Clinical and Health Psychology, PO Box 100227, Gainesville, FL 32610 Tel. 352.273.5130 Fax 352.273.5061
RESEARCH OBJECTIVE: It has been estimated that fifty percent of all individuals with psychological symptoms seek treatment from a primary care physician, and approximately twenty-five percent of patients seen in a primary care physicians office suffer from a psychological disorder. Primary care patients rarely present with prototypical symptoms, and when they do, they are often complicated by somatic complaints related to a physical condition. Thus, it is quite difficult to make an accurate assessment of the presenting psychological problem. The accuracy of diagnoses for psychological symptoms in Medicaid primary care has never been evaluated. The purpose of this study is to assess and describe the diagnosis patterns of Florida Medicaid enrollees with clinical (i.e., meets DSM-IV criteria for a specified disorder, e.g. Major Depressive Disorder) and sub-clinical (i.e., diagnosed as Not Otherwise Specified in DSM-IV) psychological conditions who seek treatment in primary care medical facilities. STUDY DESIGN: Medicaid claims data were extracted and analyzed using descriptive statistics. The Florida Agency for Healthcare Administration provided the researchers with electronic data files used to compare IDC-9 code frequencies. POPULATION STUDIED: Study participants included all Florida Medicaid Medipass recipients with a diagnosis of a psychological condition made by a primary care physician during the month of June 2001. PRINCIPAL FINDINGS: In our sample, we identified 613 Medicaid recipients with an index diagnosis of psychological disorder in June of 2001 made by a primary care physician. These recipients were continuously eligible for Medicaid during the previous six months and were all between the ages of 18 and 65. Four hundred and ninety-two (79.6%) were female and 355 (57.4%) were white. The mean age of our sample was 40.5 years. Fifty-six percent were SSI recipients, indicating significant disability. Two sub-clinical psychological conditions accounted for almost 69% of all diagnoses. Two hundred and ten diagnoses of Anxiety State, Unspecified (ICD-9 code 300.00) were made and 210 diagnoses of Depression Not Otherwise Specified (ICD-9 code 311) were made. Sixty-three percent of primary diagnoses made during the initial encounter did not change upon subsequent encounters. Of those that did change, 35% switched from a sub-clinical to a clinical diagnosis, while 38% switched from a clinical to a sub-clinical diagnosis. CONCLUSIONS: We found that 63% of our sample maintained the same diagnosis for the year following initial system encounter. Sub-clinical diagnoses are often given to patients who do not meet specific diagnostic criteria. The high proportion of sub-clinical psychological conditions diagnosed in our sample is consistent with literature suggesting that limited symptom presentation in primary care serves as a major barrier to accurate and consistent diagnosis. This may be especially relevant in a Medicaid sample, given the association between poverty and psychological distress. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Few studies have examined the diagnosis patterns of non-psychotic psychological conditions in the Medicaid population. Understanding this interaction in primary care, where most individuals seek treatment for non-psychotic psychological conditions, allows for more appropriate management of these diseases, improvement of clinical outcomes, and reduction of costs.
Publication Types:
Keywords:
- Cost Control
- Depression
- Depressive Disorder
- Depressive Disorder, Major
- Emergency Service, Hospital
- Female
- Florida
- Humans
- Medicaid
- Mental Disorders
- Physicians, Family
- Poverty
- Primary Health Care
- diagnosis
- economics
- therapy
- hsrmtgs
UI: 103624735
From Meeting Abstracts