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

1. An Integrated Electronic Lifestyle and Mental Health Patient Self-Assessment for General Practice: Design and Initial Field Study 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

2. CHAT: Case-finding & Help Assessment Tool Smoking Alcohol misuse Other drug misuse Problem gambling Physical inactivity Depression Anxiety Abuse Anger

3. Do you want help? CHAT has two key dynamics for each assessment area Sentinel question(s) [one or two] If this is negative, go on to another topic If positive, delve in further, often to complete a standard tool (e.g., PHQ-9 depression, GAD-7 anxiety) For each area assessed in depth, ask if this is something with which they would like help Either during the consult, or at a later date

4. Transformative The idea is to get at these life-style and mental health issues Systematically When proceeding in an ad hoc, opportunistic fashion such issues too often go unnoticed Proactively Get at issues that can generate ‘traditional’ healthcare problems (and costs), and that can impair effectiveness of traditional treatment

5. eCHAT Systematically get assessment from patients while they wait in General Practice Feed the information to the GP to follow-up just minutes later as part of traditional consult Appropriate environment to counsel, and possibly treat or refer And summarised to clinical notes in PMS Reception Consulting Room PMS database eCHAT Result GP reviews eCHAT responses with patient Patient undertakes eCHAT on touchscreen Practice Local Area Network

6. Big, friendly format Touch screen, one question at a time

7. Patient-facing hardware Designed and field tested with heavy fixed touchscreen PC (e.g., 3M 17” MicroTouch) Also have an iPAD version Started with hardware unlikely to ‘walk’ from a busy clinic Could also be completed in advance via web portal Suits a more self-actualising population, but our first concern is the ‘high needs’ cohort

8. Assessment and Refinement Iterative refinement and feedback NIHI Health Technology Laboratory Consecutively with two Auckland metro general practices Recruited 30 patients in first practice, 23 in second 51 of 53 completed a feedback survey

9. Survey says... * 6 patients wrote in “unsure” or “don’t know” for this question ** Only includes responses from those 13 who had answered yes to the prior question

10. Some not interested 19 patients declined to participate...

11. Patient refinement Web form paradigm and touchscreen paradigm clash a bit Found it easiest for patients to identify themselves one field at a time

12. GP refinement Very important to get GP a good “at a glance” summary of the interview results Also important that they can then drill into the details, and possibly help patient complete the survey

13. Assessment and score given Desire for help indicated Problem areas flagged Details available to view and edit

14. Summary Tool is accepted and useable for a substantial segment of patients in the GP setting 26% declined But that was to something novel, and including the machinery of a study (consent form, survey) Might be even more accepted once routine – but it’s sufficiently accepted to have an impact GP needs summary and access to detail

15. Significance Step in the direction of co-production Let the consumer do something where they can Could probably have them do their BP, pulse, oxygen saturation and BMI while they’re at it Could link to further consumer action (e.g., online CBT for depression) Iterative refinement of existing system Leveraging of NZ’s commitment to general practice computing Transforming health provider agenda Pushing back from reacting to acute presenting complaint to find opportunities to be proactive in health promotion Potentially shifts more work into General Practice – need the right incentives!

16. Next steps RCT to assess quality-of-life improvement Are patients better off 6 months after an eCHAT? Have created Web version Could do mobile version Could link to support services (Quitline, etc.) Also online guidance for GP in their role Would be best to standardise on validated eCHAT There are a number of related assessments out there Should converge on instrument that has best evidence

17. Thanks! For further information on eCHAT contact: Jim Warren, jim@cs.auckland.ac.nzor Felicity Goodyear-Smith,f.goodyear-smith@auckland.ac.nz And you can see a demo in the exhibition hall at the NIHI/HIVE stand!