Web Tool Screens Health Risks in Waiting Rooms

There is an article today in Medpage Today: Putting Breaking Medical News Into Practice about Goodyear-Smith F, et al “eCHAT for lifestyle and mental health screening in primary care” Ann Fam Med 2013; DOI: 10.1370/afm.1512.

Written by Chris Kaiser, Cardiology Editor, MedPage Today, who writes:

A pilot study using a free web-based behavior and mental health screening tool in primary care offices worked so well that practices in the study have adopted the tool as routine.

Patients who used eCHAT (electronic Case-finding and Help Assessment Tool) indicated they wanted immediate help with anxiety (9%), depression (7%), physical activity (6%), and smoking (5%), “which was not overwhelming for physicians to address,” according to Felicity Goodyear-Smith, MBChB, MD, from the department of general practice and primary health care at the University of Auckland in New Zealand, and colleagues.

Feedback from patients about using the tool on iPADs while in the waiting room and from physicians, practice managers, nurses, and receptionists was “generally positive,” researchers wrote in the study published in the latest issue of the Annals of Family Medicine.

“All seven family physicians [from both practices in the study] agreed that eCHAT could contribute to patient understanding in relation to their risky health behaviors or mental health issues through various interventions and self-management,” Goodyear-Smith and colleagues wrote.

Both practices have also continued to use eCHAT as part of routine practice and regularly receive emailed activity reports of their eCHAT usage. One practice is using eCHAT for every adult patient, while the other practice uses the tool on selected patients such as those who are new, pregnant, or have mental health issues.

eCHAT is an electronic version of the paper-based CHAT tool. The intended purpose is to systematically assess lifestyle risk factors such as smoking, problem drinking, other drug use, gambling, exposure to abuse, and physical inactivity, as well as mental health issues including depression, anxiety, and anger control.

A few patients expressed privacy concerns, particularly regarding insurance companies. Staff also inquired about how to code the data “with respect to future access to the information, particularly by insurance companies.”

“Such concerns may be difficult to alleviate,” Goodyear-Smith and colleagues said. They noted that physicians in the U.S. still harbor concerns about discrimination based on genomic data despite the passage of the Genetic Information Nondiscrimination Act of 2008 (GINA).

They also said that much of the lifestyle information gathered in eCHAT already resides in the EHR, but the “systematic approach using eCHAT only brings this latent issue into sharper focus.”

A recent study in the U.S. found “strong support” from primary healthcare clinicians and patients for including self-reported health behavior data in the electronic health record (EHR).

The eCHAT tool includes a “help question” that allows patients to indicate whether they would like help and, if so, during the current visit or later.

“We have shown that the help question significantly improves the specificity of the test,” the investigators noted.

Overall, patients found the eCHAT experience positive. They said the tool was easy to follow and didn’t take long. They liked having questions about abuse, noting that the electronic format might be an “easier way to let the doctor know if something is wrong at home.”

Interestingly, out of 19 people who had a positive score for abuse, 16 said they didn’t want help, two wanted help but not that day, and one wanted help immediately.

The pattern was similar for anger: 20 patients had a positive score, 15 declined help, two wanted help later, and three sought immediate help.

Regarding drinking, only five patients out of 63 with a positive score indicated they would accept help.

The tool also issues a red alert if a patient indicates a desire for self harm.

For the study, Goodyear-Smith and colleagues enlisted two family practices in Auckland to participate between November 2011 and February 2012.

One practice had an interest in mental health and a patient population that was relatively well-off, while the other practice was located in a deprived neighborhood and served a large number of patients with substance abuse issues.

Consecutive patients ages 16 and older were asked while in the waiting room to participate in the study. Overall 211 consented, a 91% response rate — 127 from one practice, 106 from the other.

The questionnaire was self-administered on iPADs. Physicians could then access the data on a website and download it into the EHR.

One of the benefits of the tool is that patients with positive scores can be given more specific screening questionnaires to fill out in real time while in the doctor’s office.

The study had limitations including that not all consecutive patients could be asked to participate, mostly because of the high response rate. Also, the results may not be applicable to other types of practices.

Editor Sanjay Gupta invites readers to comment on how would a tool such as eCHAT would fit into their practice.