의료보험 . 보호 자료에 표기된 정신과 진단의 진단 정확도 -경기도 연천지역 자료에서 -

Diagnostic Accuracy of the Mental Disorders Entered in the Medical Security Records

Objective ： To evaluate the diagnostic accuracy of the psychiatric diagnoses described in medical security records. Method : Using medical security records in Yonchon in 1993, 346 patients with psychiatric diagnoses(ICD-9 290-319) were sampled for the study. 13 trained interviewers visited the patients home and interviewed with semistructured interview schedule made by the authors. 13 interviewers consisted of public health doctors, social worker, nurses, psychiatric residents and psychiatrist. On each interview data of the sample patients, consensus diagnoses were made by the authors according to ICD-9 and DSM- IH -R criteria. Result ： Sensitivity, specificity and kappa value o f Schizophrenic psychoses(ICD-9 295) were 0.77, 0.97 and 0.77，respectively. Those of Affective psychoses(ICD-9 296) were 0.28，0.94 and 0.27，respectively. Those of Neurotic disorders(ICD-9 300) were 0.78，0.73 and 0.40, respectively. Those of Alcohol dependence syndrome(ICD-9 303) were 0.46, 0.99 and 0.57， respectively. Those o f Special symptoms and syndromes not elsewhere classified(ICD-9 307) were 0.47，0.94 and 0.39，respectively. Overall kappa value was 0.46. Conclusion ： Overall Kappa value was moderately acceptable. But the diagnostic accuracy of Affective psychoses was very low. It may be due to low recognition rate of depression by primary care physicians, and the obscurity of ICD-9 classification for mood disorders. Psychiatric education for primary care physicians and using self-report questionnaire for screening test will be needed to improve the diagnostic accuracy.