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iPads improve mental health screening, accountable care

By Jennifer Bresnick

- 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.”

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