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Background: The purpose of this study was to develop and evaluate a computer system that would translate patient diagnoses noted by a physician into appropriate International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes and maintain a patient-specific up-to-date problem list., Methods: The intervention consisted of a computerized list (dictionary) of diagnoses, including practice-specific synonyms and abbreviations, linked to their corresponding ICD-9-CM codes. To record the diagnoses for the office visit before the intervention, physicians used International Classification of Health Problems in Primary Care (ICHPPC-2) codes. After the intervention, physicians used their own words or checked previously identified diagnoses on the computer-generated problem list. The computer then identified the correct ICD-9-CM code. Accuracy of coding was compared before and after the new computerized system was implemented., Results: Visits in which all diagnoses matched increased from 58% to 76% (P < .001) with use of the computer system. Visits in which no computer diagnoses matched the chart decreased from 22% to 8% (P < .001). Errors of omission declined from 38% to 18% (P < .001). Errors of commission decreased from 19% to 11% (P = .006). Overall accuracy increased from 62% to 82% (P < .001)., Conclusions: Outpatient medical diagnosis coding can be simplified and accuracy improved by using a computerized dictionary of practice-specific diagnoses and synonyms linked to appropriate ICD-9-CM codes. Such a system provides a computer-generated problem list that accurately reflects the chart and assists with prompted coding on subsequent visits.

Background: Depression is one of the most common medical disorders seen in primary care practice. The purpose of this study was to estimate the prevalence of depressive symptoms in primary care patients across the United States, and to describe patient characteristics that may be associated with an increased likelihood of those symptoms., Methods: Survey data were obtained from a sample of 75,858 patients who visited one of 765 participating primary care physicians for any reason from February 1991 to September 1991. The outcome measurement used was the index score for presence of depressive symptoms on the Zung Self-rating Depression Scale., Results: The overall prevalence of clinically significant depressive symptoms was found to be 20.9%, but the percentage of patients citing depression as a reason for visit (1.2%) was markedly lower. Patients who perceived their health as poor were more likely to have severe depressive symptoms than patients who perceived their health as excellent. Women, those in older age groups, and those with lower levels of education were more likely to have clinically significant depressive symptoms than men, those in younger age groups, and those with higher levels of education. When classified by marital status within each sex, married men and women were the least likely to have clinically significant depressive symptoms., Conclusions: Clinically significant depressive symptoms are highly prevalent in primary care patients; however, depression is an infrequent patient complaint. There are certain patient characteristics that may cue the physician to consider depression in the differential diagnosis, particularly the patient's self-perception of his or her overall health status. In addition, certain other subsets of patients are at increased risk of depression, such as women, those in older age groups, and those of lower socioeconomic status.

Background: Inexpensive reminder systems are needed to ensure that primary care physicians consistently provide health maintenance services to their patients. The purpose of this study was to determine the effectiveness of a simple, inexpensive health assessment form in place of the standard chart note to increase physician compliance with mammography recommendations., Methods: A health assessment form with a reminder for screening mammography was implemented in a family practice in 1987 and was to be used as the official chart record for health maintenance visits. The charts of all women 50 years of age and older with two or more office visits during the years 1985 through 1988 were audited to determine how many mammograms were completed. Results were compared with mammography completion rates at a similar practice that did not use a health assessment form., Results: The study group showed a significant increase in mammography completion after implementation of the form, with compliance increasing from 7.3% to 32.0% (P < .001). The comparison group had an increase in mammogram completion from 12.0% to 17.8% (P < .001). The difference between the changes in rates of mammography in the two practices was statistically significant (P < .001). Among women in the study group who had a scheduled health maintenance visit during the study period the average rate of mammography completion increased from 21.2% to 65.2% (P < .001)., Conclusions: The addition of a health assessment form with a mammography reminder at the health maintenance visit is an effective and inexpensive method to increase compliance with mammography.

Background: State and federal statistics describe a lower incidence of rape and child abuse than is suggested by community prevalence rates. Victims of sexual assault may experience numerous short-term and long-term effects on psychosocial and physical health. They tend to use medical services more than nonvictims and are also more likely to seek medical care than mental health services. This study seeks to determine the prevalence of sexual victimization in a family practice setting., Methods: Women 18 years of age or older presenting to a combined family practice and university student health center for a routine Papanicolaou smear or a health maintenance visit voluntarily completed an anonymous sexual experiences questionnaire of 28 close-ended items., Results: Of 416 consecutive women, 405 agreed to participate. Of 147 family practice patients, 47.6% reported some type of contact sexual victimization during their lifetimes; 25.2% reported rape or attempted rape. Of 258 student health service patients, 57% had experienced contact sexual victimization, and 28.7% reported rape or attempted rape. Of those who reported unwanted sexual contact, 30% of the family practice patients felt they would not be comfortable discussing the experience with medical personnel, and 44.9% of the student health service patients would not feel comfortable doing so., Conclusions: Women with a history of unwanted sexual contact may be common in family practice and student health settings. Although treatment can be beneficial, many of these patients are not comfortable discussing their experiences with medical personnel. These findings suggest that there is potential benefit in obtaining a sexual victimization history as part of routine care, but further research will be necessary to assess the clinical benefit of such an approach.

Background: Primary care physicians often do not document a psychiatric diagnosis when prescribing psychotropic medications. Recent literature suggests the potential benefit of tricyclic antidepressants (TCAs) in a number of nonpsychiatric conditions (low back pain, peptic disease, fibrositis, headache, peripheral neuropathy, rheumatoid disease, and irritable colon)., Methods: Data from the 1985 National Ambulatory Medical Care Survey (NAMCS) were used to categorize the primary diagnoses given during office visits in which tricyclic antidepressants were prescribed. Comparisons were made across specialties., Results: Primary care physicians prescribed tricyclic antidepressants in 1% of all visits (an estimated 2,892,000 visits per year). Whereas 50% of these visits at which TCAs were prescribed were for documented psychiatric illnesses or conditions, 15% were for nonpsychiatric TCA-responsive conditions. The majority of visits by patients with these disorders were to primary care physicians. The pattern of TCA prescribing for these disorders by primary care physicians parallels that of other medical specialties except that primary care physicians prescribed TCAs for nonpsychiatric TCA-responsive disorders less frequently than did other medical specialists., Conclusions: When nonpsychiatric TCA-responsive disorders are included, primary care physicians document with appropriate diagnoses 15% more of their TCA prescriptions than previous studies have indicated. An understanding of the 35% of TCA prescriptions that do not show proper documentation will require further study and information not available from the NAMCS: