Oral Papers: Collaborative Care & Community C-L I
Background/Significance: Primary care clinics are increasingly using screening measures to detect individuals with psychiatric disorders including bipolar disorder and posttraumatic stress disorder (PTSD) (Han, 2016; Cerimele, 2014). No studies have evaluated psychiatrist diagnosis among primary care patients screening positive for these conditions; however, knowledge of the clinical conditions is critical for planning for appropriate service provision. We describe the clinical diagnoses for patients screening positive for bipolar disorder, PTSD, or both.
Methods: We conducted a secondary analysis of data from an ongoing large pragmatic randomized trial comparing 12-month treatment effectiveness of collaborative care and telehealth referral. Eligible participants were adult patients seen in primary care safety net clinics not currently receiving specialty psychiatric care, screening positive for PTSD on the PCL-6 (score of ≥14) and/or for bipolar disorder on the CIDI measure (score of ≥8) in 12 rural Federally Qualified Health Centers. Patients in both study arms received 12 months of treatment which included telehealth psychiatric consultation in both study arms. Clinical diagnoses were assigned by study psychiatrists and entered into a web-based registry. We extracted diagnostic categories from the clinical registry and calculated cross-tabulations based on initial positive screening results.
Results: As of March 2019, among 486 patients, 321 (66%) screened positive on the PCL-6 only, 150 (31%) screened positive on both the PCL-6 and the CIDI, with just 15 (3%) positive on the CIDI alone. The most common clinical diagnoses among PCL+ patients included PTSD (n=219, 68%), depressive disorder (n=222, 69%), anxiety disorder (n=111, 35%); and for PCL+/CIDI+ patients included PTSD (n=105, 70%), bipolar disorder (n=68, 45%), depressive disorder (n=59, 39%). Personality, alcohol, and substance use disorders each were present among 11% or more of the sample and were more prevalent among CIDI+ patients than PCL+ patients. Three-fourths of all patients had two or more psychiatric diagnoses. We anticipate full results for 710 patients by 10/1/19 to report at the November 2019 meeting.
Discussion: Primary care patients who screen positive for PTSD and/or bipolar disorder have substantial psychiatric comorbidity. Nearly all patients screening positive for bipolar disorder on the CIDI also screened positive for PTSD on the PCL-6, and most were diagnosed with PTSD, whereas most PCL+ have a comorbid mood disorder. Many patients have comorbid personality and substance use disorders.
Conclusion/Implications: This study contributes to the understanding of the psychiatric disorders among safety net primary care patients who screen positive on commonly used measures for bipolar disorder and PTSD. Results underscore the need for psychiatric consultation services to improve psychiatric management in underserved settings.