Behavior Screening Via Computer

According to the authors of recently published study results, the leading causes of adolescent morbidity and death are injury risk, depressive symptoms, and substance use, all of which are clinically relevant to psychiatry.

Adolescents are often hesitant—due to embarrassment or their belief that no problem exists—to discuss certain behaviors and symptoms face-to-face with their pediatrician or primary care physician (PCP). Because they often lack the time to conduct thorough behavioral screening, pediatricians and PCPs (who would be the ones to refer the patient to a psychiatrist for additional screening and treatment) may potentially miss numerous patients with risk-seeking behaviors.

With this in mind, researchers at the Center for Innovation in Pediatric Practices in The Research Institute at Nationwide Children's Hospital tested the utility of a computerized behavioral screening system called Health eTouch, a Web application, provided to patients on a secure wireless tablet PC, that includes questions that vary based on patient age and reported behaviors drawn from existing publicly available validated measures. What they found may help not just PCPs and pediatricians, but psychiatrists, too.

Pediatricians at urban clinics seeing 878 primary care patients age 11-20 years were randomly assigned to receive results of the computer screening just prior to a face-to-face encounter with the patient or to receive the results after two to three business days. The screening results that the pediatricians were able to view included a summary of patient response to screening questions, a list of flagged responses that could be indicative of high-risk behavior, and overall positive or negative ratings for behavioral concerns tested.

The researchers found that 59% of respondents screened positive for at least one of the high-risk behaviors mentioned above, of whom 68% were identified with a problem by a pediatrician who received screening results just prior to the face-to-face encounter, compared to just 52% identified by pediatricians who didn’t receive results for two to three days.

The study doesn’t address it, but I wonder how many of the 59% would not have been identified without the computer screening test. None? 25%? What do you think? E-mail me!

Secondarily, the researchers determined that “direct data entry by youths in waiting rooms and automated scoring and printing programs minimize staff time necessary for screening, scoring, reporting, and filing results.”

Said principal investigator, Kelly Kelleher, MD, Center for Innovation in Pediatric Practices, The Research Institute at Nationwide Children's, and faculty member, The Ohio State University College of Medicine, “Our research has found that recent advances in information technology, such as the Health eTouch system, and the immediate reporting of computerized screening results may help overcome barriers to behavioral screening."

How does this apply to psychiatry? Sure, the majority of the patients seen by a psychiatrist have been referred by a PCP or perhaps a physician in another specialty, so the screening process outlined above might have already taken place. But certainly, many, if not most, of these patients have co-morbid conditions that weren’t picked up by the referring physician. Or maybe there is an underlying behavioral issue, which the PCP may have missed in his or her original diagnosis. Or maybe a patient ends up at the psychiatrist’s office and for some reason hasn’t already undergone a screening test. Or maybe the psychiatrist is just the thorough physician he or she should be and wants to do their own screening test. Or maybe a patient is suffering from a particularly embarrassing condition/disease/situation—be it a divorce, addiction to sex, or schizophrenia—that would be easier to answer questions about via a faceless, opinion-less, non-judgmental computer.

With the above study results in mind, wouldn’t it be nice to be able to get honest answers to a test that provides immediate results?