Tablet Screening at Primary Care Visits Could Catch Depression, Domestic Violence

David P. Miller Jr., MD, MS

Patient screening via tablets or digital mediums may lead to more important disclosures and productive primary care physician-patient interactions in appointments than a standard nurse-led screening, according to findings from a new research letter.

In data from Wake Forest School of Medicine, a team of investigators noted that patients experience a greater sense of privacy—and therefore, opportunity for candidacy—when conducting their own primary care visit screening on a tablet versus speaking with a nurse. Implementing more tablet screenings could lead to clinicians identifying more patient concerns that warrant their attention in a check-up.

Led by David P. Miller Jr., MD, MS of the Department of Internal Medicine, and Anna C. Snavely, PhD, of the Department of Biostatistics and Data Science, the Wake Forest investigators sought to observe the benefit of their primary care visit-based tablet app, mPATH, on screening adults on matters including depression, fall risk and intimate partner violence.

Originally created to assist with colorectal cancer screening, mPATH may provide a more straight path toward frontline clinicians addressing health matters sometimes considered extracurricular relative to what’s covered in a standard office visit.

“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,” investigators wrote. “Self-administered screening on a tablet device could address these barriers and improve the detection of at-risk patients.”

Their nonrandomized controlled trial assessed data from 6 participating practices: 3 family medicine and 3 internal medicine offices. They sought an outcome of patients with depression, fall risk or intimate partner violence being identified within 60 days following the app’s launch, compared with being identified 60 days before when nursing staff were asking the same screening questions verbally.

Eligible patients were ≥18 years old, seen from June 2019 to February 2020.

The study included 23,026 patients, 57.9% of whom were female; 80.5% were non-Hispanic White and 13.5% were Black or African American. Mean patient age was 59.7 years old.

Use of the tablet app was considered “suboptimal” by investigators; it varied from 10.3% to 60.5% across the observed 6 clinics due to differences in front desk staff management of the devices. Nonetheless, more than twice as many tablet-screened patients were positive for at least 1 of the 3 primary outcomes than those who were screened by nurses.

Increases for each outcome were significant across all 6 clinics, as were reports of patients’ thoughts of self-harm, injurious falls, or risk of conflicts turning physical. After adjusting for patient characteristics, association of mPATH with the primary outcome was still significant (adjusted odds ratio, 2.6; 95% CI, 2.4 – 2.8).

Investigators praised the “highly pragmatic design” of the trial, complementary to previous research that showed patients’ comfort with candidacy in tablet-based screenings, as well as their benefit for busy primary care clinical staffs. That said, research limitations included investigators’ use of a single health system setting that includes a predominately White population, confounding risks in a nonrandomized trial, and the lack of validation behind screening for reported partner violence.

They concluded that the findings warrant follow-up; they are currently conducting a multisite, randomized, controlled cluster trial that seeks to define effective incorporation of mPATH into standard screening and care.

The study, “Universal Screening in Primary Care Practices by Self-administered Tablet vs Nursing Staff,” was published online in JAMA Network Open.