eCHAT for Lifestyle and Mental Health Screening in Primary Care

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 accessed by a family physician on the website and in the electronic health record (EHR) at the point of care. METHODSWe 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. RESULTSOf 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.

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Preconsult interactive computer-assisted client assessment survey for common mental disorders in a community health centre: a randomized controlled trial

“…Most of these studies have used small convenience samples, 24,[43][44][45] with the exceptions of eCHAT, Promote Health and My Own Health Report (MOHR). 22,46,47 Each of these studies, although valuable, either does not include a control group (eCHAT), is limited to academic settings with an above average income population (Promote Health) or is not widely available for use (MOHR). In this emerging area of patient-centred clinical informatics, the iCCAS study advances the field by recruiting an immigrant, refugee and ethnoracially diverse patient population from a community health centre and using rigorous randomized controlled design.…”

Patient-Entered Wellness Data and Tailored Electronic Recommendations Increase Preventive Care

“…One study conducted in New Zealand demonstrated the feasibility of an electronic lifestyle assessment tool similar to the IWT. 22 While the results of that assessment may be downloaded from a website to the electronic medical record by the provider, they do not drive automatic order prompts, thus increasing the steps required to implement a relevant care plan. Despite this difference, most patients in that study found the tool easy to use, and feedback from providers was positive.…”