Improving Patient-Centered Care for Young People in General Practice With a Codesigned Screening App: Mixed Methods Study

Abstract

BackgroundDespite experiencing a high prevalence and co-occurrence of mental health disorders and health-compromising behaviors, young people tend not to seek professional help for these concerns. However, they do regularly attend primary care, making primary care providers ideally situated to identify and discuss mental health and lifestyle issues as part of young people’s routine health care.ObjectiveThe aim was to investigate whether using a codesigned health and lifestyle-screening app, Check Up GP, in general practice influenced young people’s assessment of the quality of their care (measures of patient-centered care and youth friendliness), and their disclosure of sensitive issues. In addition, this study aimed to explore young people’s acceptance and experience of using a screening app during regular health care.MethodsThis was a mixed methods implementation study of Check Up GP with young people aged 14 to 25 years attending a general practice clinic in urban Melbourne, Australia. A 1-month treatment-as-usual group was compared to a 2-month intervention group in which young people and their general practitioners (GPs) used Check Up GP. Young people in both groups completed an exit survey immediately after their consultation about disclosure, patient-centered and youth-friendly care, and judgment. In addition, participants in the intervention group were surveyed about app acceptability and usability and their willingness to use it again. Semistructured interviews with participants in the intervention group expanded on themes covered in the survey.ResultsThe exit survey was completed by 30 young people in the treatment-as-usual group and 85 young people in the intervention group. Young people using Check Up GP reported greater disclosure of health issues (P<.001), and rated their GP higher in patient-centered care: communication and partnership (P=.01), personal relationship (P=.01), health promotion (P=.03), and interest in effect on life (P<.001). No differences were found on core indicators of youth-friendly care: trust, level of comfort, expectations met, and time to ask questions. In all, 86% (73/85) of young people felt the app was a “good idea” and only 1% (1/85) thought it a “bad idea.” Thematic analysis of qualitative interviews with 14 participants found that Check Up GP created scope to address unmet health needs and increased sense of preparedness, with use moderated by honesty, motivation, app content and functionality, and app administration.ConclusionsIntegrating a health and lifestyle-screening app into face-to-face care can enrich young people’s experience of seeing their GP, create scope to identify and address unmet health needs, and increase patient-centered care. Further research is needed to investigate the effect of using a health and lifestyle-screening app in a diverse range of clinic types and settings, and with a diverse range of GPs and youth.

Patient centred consultation, satisfaction and young patients: A cross-country analysis

“…In addition, it may be possible to identify psychological and social factors influencing health-risk behaviors such as smoking and alcohol consumption [29,30,31,32]. Several studies revealed that the assessment of psychological and social issues during medical consultations is related to positive experience, disclosure, and engagement with care of adolescents and young adults [33,34,35], supporting the current results. Furthermore, the present findings are consistent with a review conducted by Ambresin et al [36] Table 4).…”

Youth StepCare: A pilot study of an online screening and recommendations service for depression and anxiety among youth patients in general practice.

“…The initial interest (78.3%) and uptake (77.8%) in eligible youth patients was high, especially when compared to other trials. For example, less than half of the youth who were approached to use the Check Up GP service accepted the invitation (26). Our higher rates of participation may be due to the youth patients being approached by the practice staff on arrival rather than by the GP (as in mobiletype) or over the phone by practice staff (as in Check Up GP).…”

“…Our higher rates of participation may be due to the youth patients being approached by the practice staff on arrival rather than by the GP (as in mobiletype) or over the phone by practice staff (as in Check Up GP). When considering the short screening period of this trial, the number of youth screened is equivalent to similar youth studies (26,34). Unfortunately, due to the pace of the front-of-practice procedures and lack of access to patient-level data, it was not possible to determine the total number of adolescents who visited the participating GPs during the trial period and were not approached (i.e.…”

“…Two similar screening services have also been trialled in Australia to meet the unique needs of adolescents. Webb et al (26) examined the acceptability and effectiveness of Check Up GP for improving self-disclosure and Reid et al (27) examined the effectiveness of mobiletype for improving mental health outcomes. Check Up GP was found to increase the disclosure of sensitive issues, and through up-skilling of GPs, the participants using mobiletype experienced substantially improved mental health outcomes overall, demonstrating the usefulness of such screening programs within primary care.…”

Youth StepCare: a pilot study of an online screening and recommendations service for depression and anxiety among youth patients in general practice

“…Technology-based screening services for mental illness have now been implemented in various healthcare settings. For adults, the UK's Integrating Mental and Physical healthcare: Research Training and Services (IMPARTS [23]) program and the Australian StepCare [24,25] service provide hospital specialists and GPs with a tool to screen patients' mental health symptoms prior to their appointment, with results integrated into medical software for immediate review. Both services were found to be acceptable for use among practitioners and patients and feasible to implement within their intended clinical context [23][24][25].…”