Patients Conducting Self-Administered Screening Report More Medical Concerns
A March 8 Research Letter entitled, “Universal Screening in Primary Care Practices by Self-administered Tablet vs Nursing Staff,” from JAMA Network Open, finds a self-administered screening with a tablet-based app detected twice as many patients with immediate medical concerns when compared to verbal screening in a primary care setting.
The authors state that “Screening primary care patients for depression, injurious falls, or intimate partner violence is hampered by time pressures, staff discomfort, and patients’ reluctance to disclose sensitive information. Self-administered screening on a tablet device could address these barriers and improve the detection of at-risk patients.”
Further, “Our team created an app, called mPATH, that patients access on a tablet at their primary care office to assist with colorectal cancer screening. To encourage practices to use the app, we included screening questions for depression (Patient Health Questionnaire-2 and -9),3 fall risk,4 and intimate partner violence that the participating health system requires nursing staff to ask at every visit. All adult patients were given the tablet with the app at check-in, and it transmitted results to the electronic health record. We are currently conducting a cluster randomized implementation-effectiveness study of the app in community-based practices with an anticipated completion date in March 2023 (NCT03843957). For this nonrandomized controlled trial, we evaluated data from the first 6 participating practices (3 family medicine and 3 internal medicine) to determine if more patients with depression, fall risk, or intimate partner violence were identified in the 60 days after the app was launched compared with 60 days before, when nursing staff were asking the same screening questions verbally. We included all patients aged 18 years or older seen during these periods (June 2019 to February 2020). To avoid confounding from COVID-19, we truncated the post period for the last 2 enrolled clinics at 30 days.”
The authors explain that there were 23,026 patients in the study, 57.9 percent were female, 80.5 percent were non-Hispanic white, and 13.5 percent were Black or African American; mean age was 59.7 years (range, 18-102 years).
Across six clinics, use off the app varied from 10.3 percent to 60.5 percent—the authors cite differences in how often front desk staff handed the tablet to patients.
“Despite suboptimal uptake, more than twice as many patients screened positive after the app was launched,” the authors add. “Significant increases were seen across all clinics and for all screening domains, including for patients who reported thoughts of self-harm, injurious falls, or ‘that conflicts sometimes turn into physical fights.’”
The authors say that compared with verbal screening, having patients self-administer with a tablet-based app finds more than twice as many immediate medical concerns. Prior studies have shown that patients feel that being screen with a tablet is more private and that sometimes busy clinical staff don’t properly ask screening questions.
The authors conclude that “Limitations of our study include the single health system setting with a predominantly White population, the risk of confounding inherent in any nonrandomized study, and the lack of validation of the health system’s intimate partner violence screening questions. We are currently conducting a multisite randomized controlled cluster study to identify effective strategies for incorporating the program into routine care, and results will be forthcoming.”
