An Integrated Electronic Lifestyle and Mental Health Patient Self-Assessment for General Practice: Design and Initial Fiel...
CHAT: Case-finding & Help Assessment Tool<br />Smoking 	<br />Alcohol misuse <br />Other drug misuse<br />Problem gambling...
Do you want help?<br />CHAT has two key dynamics for each assessment area<br />Sentinel question(s) [one or two]<br />If t...
Transformative<br />The idea is to get at these life-style and mental health issues<br />Systematically<br />When proceedi...
eCHAT<br />Systematically get assessment from patients while they wait in General Practice<br />Feed the information to th...
Big, friendly format<br />Touch screen, one question at a time<br />
Patient-facing hardware<br />Designed and field tested with heavy fixed touchscreen PC (e.g., 3M 17” MicroTouch)<br />Also...
Assessment and Refinement<br />Iterative refinement and feedback<br />NIHI Health Technology Laboratory<br />Consecutively...
Survey says...<br />*    6 patients wrote in “unsure” or “don’t know” for this question<br />**  Only includes responses f...
Some not interested<br />19 patients declined to participate...<br />
Patient refinement<br />Web form paradigm and touchscreen paradigm clash a bit<br />Found it easiest for patients to ident...
GP refinement<br />Very important to get GP a good “at a glance” summary of the interview results<br />Also important that...
Assessment and score given<br />Desire for help indicated<br />Problem areas flagged<br />Details available to view and ed...
Summary<br />Tool is accepted and useable for a substantial segment of patients in the GP setting<br />26% declined<br />B...
Significance<br />Step in the direction of co-production<br />Let the consumer do something where they can<br />Could prob...
Next steps<br />RCT to assess quality-of-life improvement<br />Are patients better off 6 months after an eCHAT?<br />Have ...
Thanks!<br />For further information on eCHAT contact:<br />Jim Warren, jim@cs.auckland.ac.nzor<br />Felicity Goodyear-Smi...
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An Integrated Electronic Lifestyle and Mental Health Patient Self-Assessment for General Practice: Design and Initial Field Study

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Jim Warren
National Institute for Health Innovation, University of Auckland
(4/11/10, Square, 10.00)

Published in: Health & Medicine
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An Integrated Electronic Lifestyle and Mental Health Patient Self-Assessment for General Practice: Design and Initial Field Study

  1. 1. An Integrated Electronic Lifestyle and Mental Health Patient Self-Assessment for General Practice: Design and Initial Field Study<br />Jim Warren1, Felicity Goodyear-Smith2, Denise Miller2, Debra Warren1, Chris Paton1, Thusitha Mabotuwana1 and Bruce Arroll21 National Institute for Health Innovation 2 Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, Auckland, New Zealand<br />
  2. 2. CHAT: Case-finding & Help Assessment Tool<br />Smoking <br />Alcohol misuse <br />Other drug misuse<br />Problem gambling <br />Physical inactivity<br />Depression<br />Anxiety <br />Abuse <br />Anger <br />
  3. 3. Do you want help?<br />CHAT has two key dynamics for each assessment area<br />Sentinel question(s) [one or two]<br />If this is negative, go on to another topic<br />If positive, delve in further, often to complete a standard tool (e.g., PHQ-9 depression, GAD-7 anxiety)<br />For each area assessed in depth, ask if this is something with which they would like help<br />Either during the consult, or at a later date<br />
  4. 4. Transformative<br />The idea is to get at these life-style and mental health issues<br />Systematically<br />When proceeding in an ad hoc, opportunistic fashion such issues too often go unnoticed<br />Proactively<br />Get at issues that can generate ‘traditional’ healthcare problems (and costs), and that can impair effectiveness of traditional treatment<br />
  5. 5. eCHAT<br />Systematically get assessment from patients while they wait in General Practice<br />Feed the information to the GP to follow-up just minutes later as part of traditional consult<br />Appropriate environment to counsel, and possibly treat or refer<br />And summarised to clinical notes in PMS<br />Reception<br />Consulting Room<br />PMS database<br />eCHAT Result<br />GP reviews eCHAT responses with patient<br />Patient undertakes eCHAT on touchscreen<br />Practice Local Area Network<br />
  6. 6. Big, friendly format<br />Touch screen, one question at a time<br />
  7. 7. Patient-facing hardware<br />Designed and field tested with heavy fixed touchscreen PC (e.g., 3M 17” MicroTouch)<br />Also have an iPAD version<br />Started with hardware unlikely to ‘walk’ from a busy clinic<br />Could also be completed in advance via web portal<br />Suits a more self-actualising population, but our first concern is the ‘high needs’ cohort<br />
  8. 8. Assessment and Refinement<br />Iterative refinement and feedback<br />NIHI Health Technology Laboratory<br />Consecutively with two Auckland metro general practices<br />Recruited 30 patients in first practice, 23 in second<br />51 of 53 completed a feedback survey<br />
  9. 9. Survey says...<br />* 6 patients wrote in “unsure” or “don’t know” for this question<br />** Only includes responses from those 13 who had answered yes to the prior question<br />
  10. 10. Some not interested<br />19 patients declined to participate...<br />
  11. 11. Patient refinement<br />Web form paradigm and touchscreen paradigm clash a bit<br />Found it easiest for patients to identify themselves one field at a time<br />
  12. 12. GP refinement<br />Very important to get GP a good “at a glance” summary of the interview results<br />Also important that they can then drill into the details, and possibly help patient complete the survey<br />
  13. 13. Assessment and score given<br />Desire for help indicated<br />Problem areas flagged<br />Details available to view and edit<br />
  14. 14. Summary<br />Tool is accepted and useable for a substantial segment of patients in the GP setting<br />26% declined<br />But that was to something novel, and including the machinery of a study (consent form, survey)<br />Might be even more accepted once routine – but it’s sufficiently accepted to have an impact<br />GP needs summary and access to detail<br />
  15. 15. Significance<br />Step in the direction of co-production<br />Let the consumer do something where they can<br />Could probably have them do their BP, pulse, oxygen saturation and BMI while they’re at it<br />Could link to further consumer action (e.g., online CBT for depression)<br />Iterative refinement of existing system<br />Leveraging of NZ’s commitment to general practice computing<br />Transforming health provider agenda<br />Pushing back from reacting to acute presenting complaint to find opportunities to be proactive in health promotion<br />Potentially shifts more work into General Practice – need the right incentives!<br />
  16. 16. Next steps<br />RCT to assess quality-of-life improvement<br />Are patients better off 6 months after an eCHAT?<br />Have created Web version<br />Could do mobile version<br />Could link to support services (Quitline, etc.)<br />Also online guidance for GP in their role<br />Would be best to standardise on validated eCHAT<br />There are a number of related assessments out there<br />Should converge on instrument that has best evidence<br />
  17. 17. Thanks!<br />For further information on eCHAT contact:<br />Jim Warren, jim@cs.auckland.ac.nzor<br />Felicity Goodyear-Smith,f.goodyear-smith@auckland.ac.nz<br />And you can see a demo in the exhibition hall at the NIHI/HIVE stand!<br />

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