Technology may be the key to identifying high-risk behaviors among adolescents. Injury risk, depressive symptoms and drug and alcohol use are the leading causes of adolescent morbidity and mortality; yet pediatricians often lack the time to screen for these behavioral concerns. That paradox of care is the motivation behind a new study, published in the June issue of Pediatrics, which found adolescents who participated in computerized screening with real-time results were more likely to be identified as having a problem by their pediatrician than adolescents whose screening results were delayed.
The study, conducted by researchers at the Center for Innovation in Pediatric Practices in The Research Institute at Nationwide Childrens Hospital, compared the results of 878 primary care patients, ages 11 to 20 years, who participated in a unique, computerized behavioral screening system between June 1, 2005 and February 20, 2006 called Health eTouch. Developed by researchers at Nationwide Childrens, Health eTouch is a Web application, presented to patients on secure wireless Web tablets with 10-inch touch screen displays. Questions vary based on the users age and reported behaviors and are drawn from existing publicly available validated measures.
Study participants took part in Health eTouch screening in the waiting rooms of the urban clinics they attended. These clinics were randomly assigned to have pediatricians either receive screening results just prior to face-to-face encounters with patients Immediate Results condition or two to three business days later Delayed Results condition. When provided with the screening results, pediatricians were able to view a summary of patient responses to screening questions, as well as a list of flagged responses thought to be indicative of high-risk behaviors and an overall positive or negative rating for various behavioral concerns tested during the screening process.
After participating in Health eTouch, 59 percent of respondents screened positive for at least one of the following behavioral concerns: injury risk behaviors, significant depressive symptoms or substance use. Of those youths who screened positive and whose results were provided to pediatricians just prior to their consultation, 68 percent were identified as having a problem by their pediatrician, while only 52 percent of youths whose results were delayed were identified as having a problem by their pediatrician.
Routine behavioral screening, although critical in identifying and addressing high-risk behaviors, often does not occur or is limited due to the time constraints and competing demands facing primary care physicians, said Kelly Kelleher, MD, MPH, a principal investigator for the Center for Innovation in Pediatric Practices in The Research Institute at Nationwide Childrens and a faculty member at 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.
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. Also, past research has shown adults and adolescents are more willing to disclose sensitive information to a computer than to a clinician.