ArticleCanadian family physician Medecin de famille canadien
Characterizing mental health diagnosis within Canadian primary care settings: Application of validated electronic medical record case definitions.
Article in Canadian family physician Medecin de famille canadien. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo validate a primary care electronic medical record (EMR) case definition for mood and anxiety disorders (including depression, anxiety, and bipolar disorder) and schizophrenia that can be used to estimate prevalence and co-occurrence.
designRetrospective cross-sectional study.
settingCanada.
participantsDe-identified EMR data was used from 1574 primary care providers participating in the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) from 1,692,987 patients who had 1 or more visits with a primary care provider. The reference set included 2488 patients, with 434 positive and 2054 negative for 1 or more mental health conditions of interest. A second reference set for schizophrenia represented 760 patients (30 positive and 730 negative).
main outcome measuresThe agreement of 29 case definitions was assessed against a reference set by reporting sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy. Prevalence was estimated and co-occurrence was assessed in the CPCSSN dataset (N=1,692,987).
resultsThe strongest definition for mood disorders captured anxiety, depression, and bipolar disorder with a sensitivity of 80.7%, specificity of 88.7%, PPV of 59.9%, and NPV of 95.7%; and an estimated prevalence of 21.8% (95% CI 21.7 to 21.9). The inclusion of psychosis did not improve agreement (sensitivity 95.2%, specificity 80.7%, PPV 51.0%, NPV 98.8%), but schizophrenia alone had high agreement (sensitivity 93.3%, specificity 100%, PPV 100%, NPV 99.9%).
conclusionHigh co-occurrence of anxiety, depression, and bipolar disorder was found. Algorithms validated to capture these conditions together produced stronger agreement compared with individual definitions. Schizophrenia was less likely to co-occur with other mental health conditions and produced higher agreement when validated separately. Application of validated algorithms to capture mental health conditions can inform disease surveillance and health system planning.
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