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

Abstract

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.”