eCHAT: lifestyle and mental health screening

GOODYEAR-SMITH F, WARREN J, BOJIC M, CHONG A. Annals of Family Medicine, 2013. 11(5): 460-466.
doi: 10.1370/afm.1512


PURPOSE Early detection and management of unhealthy behaviors and mental health issues in primary care has the potential to prevent or ameliorate many chronic diseases and increase patients’ well-being. This study aimed to assess the feasibility and acceptability of the systematic use of a Web-based eCHAT (electronic Case-finding and Help Assessment Tool) screening patients for problematic drinking, smoking, and other drug use, gambling, exposure to abuse, anxiety, depression, anger control, and physical inactivity, and whether they want help with these issues. Patients self-administered eCHAT on an iPad in the waiting room and received summarized results, including relevant scores and interpretations, which could be by a family physician on the website and in the electronic health record (EHR) at the point of care.

METHODS We conducted a mixed method feasibility and acceptability study in 2 general practices in Auckland, New Zealand. Participants were consecutive adult patients attending the practice during a 2-week period, as well as all practice staff. Patients completed eCHAT, doctors accessed the summarized reports. Outcome measures were patients’ responses to eCHAT, and patients’ written and staff recorded interview feedback.

RESULTS Of the 233 invited patients, 196 (84%) completed eCHAT and received feedback. Domains where patients wanted immediate help were anxiety (9%), depression (7%), physical activity (6%), and smoking (5%), which was not overwhelming for physicians to address. Most patients found the iPad easy to use, and the questions easy to understand and appropriate; they did not object to questions. Feedback from 7 doctors, 2 practice managers, 4 nurses, and 5 receptionists was generally positive. Practices continue to use eCHAT regularly since the research was completed.

CONCLUSIONS eCHAT is an acceptable and feasible means of systemic screening patients for unhealthy behaviors and negative mood states and is easily integrated into the primary care electronic health record.

An alert about this paper iPads improve mental health screening was published in EHR Intelligence by Jennifer Bresnick on 10 Sep 2013

Letting patients fill out a mental health evaluation on an iPad in the waiting room can help prompt more honest answers and facilitate greater patient engagement says a study published in the latest edition of the Annals of Family Medicine. Lead researcher Dr. Felicity Goodyear-Smith of the University of Auckland found that giving patients a tablet while they waited for their appointment and asking them to take a web-based questionnaire called the electronic Case-finding and Help Assessment Tool (eCHAT) was an effective way to pinpoint mental and behavioral issues using data that could be sent directly into the patient’s EHR.
“Unhealthy behaviors and mental health issues are major contributors to the burden of chronic disease suffered by many primary care patients,” Goodyear-Smith writes. “Early detection and helping patients in self-management can assist in primary and secondary prevention.” To promote thorough and systematic screenings for mental issues during a primary care visit, the researchers used the eCHAT assessment to gauge depression, anxiety, anger control, exposure to abuse, and other lifestyle factors like alcohol and tobacco use.
They also asked patients if they wanted help with their issues from their physician, which gave providers a clear indicator of what to focus on during the visit. “The clinicians have the choice or reading the summarized reports off the eCHAT web-site, cutting and pasting these into the clinical notes, or clicking a button to load results into the EHR, entered in the screening and diagnosis fields,” the researchers explained. “A red alert is provided if the patient’s responses are positive for self-harm. Evidence indicates that when a patient identifies an issue as a problem, it is more likely to be solved than when it is identified by their health care clinician.”
More than 80% of the patients given the opportunity to participate did complete the assessment, and patients reported that the questions were easy to understand and unobjectionable. The practices that took part in the study continued to use the eCHAT questionnaire after the research period ended, and believed it was helpful for collecting metrics such as smoking status while integrating easily into their workflows.
Goodyear-Smith believes that the current climate of accountable care and patient-centered medicine is favorable for integrating similar tools and assessments. “Because information is collected, analyzed automatically, and transferred seamlessly to EHR in real time to be accessed by the clinician, it is an efficient and cost-effective way of assessing some of patients’ major lifestyle health risks. It further minimizes the chance of missing opportunities to provide early health care. eCHAT puts the patient, not the disease, in the center with a whole-person orientation.”

Castle Campbell

Today we visited Castle Campbell just north of Dollar.

Campbell Castle

Colin Campbell, the 1st Earl of Argyll, and Lord Chancellor of Scotland, inherited it through marrying Isabelle Stewart, daughter of John Stewart, the 2nd Lord Lorne in 1465. Colin Campbell (1433 – 1493) was my 10th great grandfather.

It was named Castle Glowm but Colin Campbell had the name changed to Castle Campbell by an Act of Parliament in 1489.

They certainly lived in style. The bed chamber had an en suite latrine built inside the wall and a stone hand basin both draining outside. One bedroom had a huge vaulted ceiling. There are grotesque faces carved in the ceiling from which chandeliers once hung.
Chandelier holder in bedroom
The great hall would have had a high table at one end, a gallery for minstrels and a huge fireplace.

Built on a hill, the view is spectacular, looking down over their terraced gardens and woodlands down to the village of Dollar with rolling meadows to the Forth River and then the hills beyond.

View from Castle Campbell
The 2nd Earl of Argyll, Gillespie Archibald Campbell (1466 – 1513), my 9th great grandfather, added on an extra hall and cellars. He later died at the battle of Floden in 1513. The castle also has a particularly nasty pit prison, which is basically a square stone hole with a trapdoor roof, for punishing offending serfs, which would not have been pleasant to spend any time in.

An inventory listing the furnishings and property includes tapestries, which would have covered the walls, curtains, tablecloths, chandeliers and pieces of armour.

The 8th Earl aquired a town house in Stirling beside Stirling Castle, previously owned by the 1st Earl of Stirling, which came to be called Argyll Lodgings, which we will visit tomorrow. The Castle was eventually burnt by Oliver Cromwell in 1654 and left to fall to ruin. It is now a Historic Scotland site under the care of the National Trust for Scotland. The current head of the Campbell clan, the 8th Duke of Argyll, now lives with wife and children in Inveraray Castle in the north.

My 8th great grandfather, Donald Campbell (d 1562), was the 4th son of the 2nd Earl, so we are not direct descendants from the later Earls nor Marquis. The 8th Earl, Archibald, was made 1st Marquis in 1641 by Charles 1, and crowned Charles II in 1651, he subsequently fell out of favour with the King who had him beheaded in Edinburgh in 1661.

Researching paternal ancestry at St Andrews Library

Yesterday Judith and I visited the Special Collections at the St Andrews library archives where they had organised for us to view books pertaining to our ancestors. The books were brought out from an atmosphere-controlled room wrapped in cloths and we had to prop them up on padded stands to protect the spines when we opened them.

A number of our great grand fathers attended St Andrews University, starting with my 5th great grandfather John Campbell in 1677, and we viewed their academic records. There was also a newspaper article which included a photograph of a portrait of my 3rd great grandfather, the Reverend George Campbell, and 2 volumes by his son (brother to my 2nd great grand father) Baron John Campbell Life of John, Lord Campbell, Lord High Chancellor of Great Britain 2 vols, 1881 edited by his daughter, the Hon Mrs Hardcastle in which he gives a history of his genealogy in the first chapter.

There were also two volumes of ‘Memoirs of my Indian Career’, by Sir George Campbell, ed. Bernard with portrait; Gent. Mag. 1854, ii. 75, 76. Sir George Campbell, my great great uncle, describes his life in India and includes a number of references to his brother John Scarlett (my great grandfather) who also served there, and in fact my grandfather was born there during this time.

Judith scanned many pages and in time we will use the information to update our paternal genealogy.

St Andrews University is 600 years old and it was wonderful to be able to walk around some of the old buildings still standing in the village.

Patient and family perceptions of hospice services: “I knew they weren’t like hospitals”

Bray Y, Goodyear-Smith F. Patient and family perceptions of hospice services: “I knew they weren’t like hospitals”. Journal of Primary Health Care, 2013. 5 (3):206-213.

The vision for palliative care service provision in New Zealand is for all people who are dying and their families to have timely access to culturally appropriate, quality palliative care services. An Auckland hospice’s records show that the ethnically diverse population statistics were not reflected in the referrals for hospice services. The aim of this research was to gain a patient-and-their-family perspective on the hospice, including exploration of components of service care that could be improved for various cultural groups.
Patients currently under the care of the hospice and family members were recruited from hospice records. Semi-structured interviews were conducted to explore the emerging issues. The study collected data from a purposive sample of 18 palliative care patients or carer family members, ranging in age from 39 to 81 years, who reflected the ethnic diversity of the population of the region. Interviewing was carried out by an experienced research assistant and continued until data saturation was reached.
Four key themes emerged—hospice personnel’s approach to patients, quality of service, cultural barriers, and strategies for future improvement. It was determined that the latter two were the most significant to address in this article.
The study revealed the need for information-giving and education, including public profiling of the hospice to strengthen community involvement. Strategies to reduce ethnic disparities include strengthening the awareness of, and access to, services by connecting with cultural groups through churches, community and specific cultural media.

Full text here

When is acute persistent cough in school-age children and adults whooping cough?

Philipson K, Goodyear-Smith F, Grant C, Chong A, Turner N, Stewart S. British Journal of General Practice. Aug 2013, 63(613), e573-e579(7)
Background: Pertussis is a vaccine modified disease in most age groups and hence subtle in its presentation. Current diagnostic approaches require relatively invasive sampling.
Aim: To determine the incidence of B. pertussis infection among people aged 5-49 years identified in primary care with acute persistent cough using an oral fluid based diagnostic test.
Design and setting: Active surveillance of acute persistent cough of 2 weeks duration or greater was established in Auckland, New Zealand from May to October 2011. The 15 participating primary care practices provided care for a socioeconomically diverse population.
Method: Recent B. pertussis infection was determined by measurement of IgG antibodies to pertussis toxin (PT) in an oral fluid sample. An IgG antibody titre to PT of ≥70 arbitrary units defined recent infection. Participants reported symptoms at presentation and kept a cough diary.
Results: A total of 226 participants were enrolled: 70 (31%) were children (5-16 years) and 156 (69%) were adults (17-49 years). Oral fluid samples were obtained from 225 participants. Ten per cent (23/225) had recent B. pertussis infection including a larger proportion of children than adults (17% versus 7%, P = 0.003). Neither cough duration nor any individual symptom discriminated between those with and without recent B. pertussis infection.
Conclusion: Pertussis is a frequent cause of acute persistent cough presenting to primary care. Clinical differentiation of pertussis from other causes of acute persistent cough is difficult. An oral fluid based diagnostic test, which is less invasive than other diagnostic approaches, has high acceptability in primary care.
This paper has just been published in the British Journal of General Practice.

A media release ‘Pertussis vaccine needed for adults working with children, says study’, by The Press Association, 8 August, 2013 reports that the study suggests that immunisation against whooping cough should be made available for adults who work in close contact with children.