by Gerald D Klee, MD, Editor, The Maryland Psychiatrist
[Winter 1998; Vol.25 No. 3]
It is now well known that untreated depression has many negative health consequences, especially in older adults. The diagnosis is often missed in primary care settings. In response to this problem, Allen Y. Tien, MD, MHS has received a grant* to develop a computer based system for the identification, assessment and longitudinal follow-up of depressive symptoms and depression. The test will be suitable for older adults in primary care settings.
Dr. Tien, is President and Research Director of Medical Decision Logic, Inc., a medical infomatics company and a member of the medical staff of the Johns Hopkins Department of Psychiatry.
Building on extensive clinical and research experience in geriatric psychiatry Tien and his colleagues are developing user friendly systems for testing elderly patients for symptoms of depression and cognitive impairment. Functional status will also be evaluated.
Many studies since the work of Shepherd et al (1) over thirty years ago reveal that mental disorders are common in the primary care setting, but frequently go unrecognized. This can lead to increases in morbidity and mortality. Primary care physicians, especially under managed care, seldom have the time or resources to adequately evaluate patients for these disorders. Depression and functional status in the elderly are known to be strongly associated with outcome. Previous studies by Pearl German et al (2) of the Hopkins school of Public Health suggest that screening for depression among older patients in medical settings may be especially useful. Computer based systems can help to identify these problems in patients efficiently and at low cost. Dr. Tien emphasizes that the computer will permit more effective physician-patient interaction, rather than being a substitute for it.
In this project Dr. Tien will develop software and hardware that will be designed to be as useful as possible for older persons with varying degrees of physical and sensory limitations. In order to make this system useful to the primary care physician, the project there will be quantitative feedback and regular discussion groups with physicians and health care staff. The will provide good quality data useful for both optimizing clinical care and conducting longitudinal research in the primary care setting.
Dr. Tien is a member of the Maryland Psychiatric Society Computers in Psychiatry Committee. His web site address is http://www.md-logic.com
*A Small Business Innovation Research (SBIR) Phase I Award from the National Institute of Mental Health title “Primary Care Geriatric Depression Screening”
References:
1) Shepherd, M, Cooper, B, Brown, A.C, Kalton, G.W. (1966) Psychiatric Illness in General Practice., London, Oxford University Press
2) German, P., Shapiro, S., et al (1987) “Detection and management of mental health problems of older patients by primary care providers.” Journal of the American Medical Association 257: 489-493