Health care providers can play a crucial role when counseling teens on mental health concerns and risky behaviors that can undermine health, such as alcohol and tobacco use, substance abuse, violence or sexual activity. In fact, numerous health organizations, such as the American Academy of Pediatrics, recommend health risk assessments as standard of care during annual adolescent well-child visits. However, studies show that less than a quarter of providers initiate these discussions with their teen patients, citing time constraints, confidentiality issues and other barriers.
Lindsay Thompson, M.D., M.S., assistant director of clinical research at UF’s Institute for Child Health Policy, and the team of researchers who worked on the project hope to encourage that dialogue between adolescent patients and their providers with the help of a new health-information technology (HIT)-based tablet for use in pediatric and family practice health care clinics.
In the July 12, 2016 Maternal and Child Health Journal, the team of researchers describe the HIT system they developed, along with the results of a recent pilot study involving 163 adolescents at 22 clinics showing that the HIT technology appeared to help facilitate discussions between teens and their doctors.
Thompson, who led the development of the paper and played an integral role in the project, worked alongside child health researchers at UF and Florida State University (FSU) to develop the system with funding from the UF CTSI’s first NIH Clinical and Translational Science Award and the state of Florida. Other members of the team included Martin Wegman, a pre-doctoral fellow in the Department of Health Outcomes and Policy and M.D.-Ph.D. candidate at UF; Keith Muller, Ph.D., professor and associate chair of the Department of Health Outcomes and Policy at UF; Katie Z. Eddleton in the Department of Health Outcomes and Policy at UF; Michael Muszynski, M.D., in the College of Medicine at FSU; Mobeen Rathore, M.D., in the Department of Pediatrics at UF in Jacksonville; Jessica De Leon, Ph.D., in the College of Medicine at FSU; and Elizabeth Shenkman, Ph.D., chair of the Department of Health Outcomes and Policy, director of the Institute for Child Health Policy at UF, co-director of the UF CTSI, and principal investigator of the project.
The HIT system adapts an existing health risk assessment that covers such topics as nutrition, drugs, sexuality, suicide and depression, safety and cyberbullying. The questionnaire can be administered to teens at the beginning of a clinic visit via a tablet (iPad) equipped with software that restricts access to the information to ensure the security and confidentiality of their responses. The survey takes no longer than 15 minutes to complete, and, importantly these reports are available for the provider in real time and can be printed or uploaded into the patient’s medical record. The HIT system also generates a list of tailored links to local community resources that clinic staff can print, scan into a smartphone or email to the patient for follow-up to assist in engagement and appropriate referrals.
To test the system, the team recruited providers and staff in 22 clinics and 163 patients ages 14-18 from within a North Central Florida practice-based research network known as Health IMPACTS (Integrating Medical Practice and Community-based Translational Science) for Florida. Health IMPACTS for Florida is managed jointly by the University of Florida and Florida State University and laid crucial groundwork for the statewide network, the OneFlorida Clinical Research Consortium. The 163 patients included an equal number of boys and girls from diverse ethnic and racial backgrounds. Of the 163 adolescents who participated in the study, 99 completed the HIT survey and the other 64 received regular care.
In a follow-up survey a few weeks after the clinic visit, teens who completed the HIT survey were significantly more likely to report that they received screening and counseling for depression, mental health, emotions, and relationships, and to describe the care they received as more private and confidential than those who received regular care.
Those responses did not differ significantly by gender, race, ethnicity, or age, and a statistical analysis of the data indicated that the teens’ responses were unrelated to the clinic they attended. Thompson said that while the study did not measure whether the HIT system may have influenced the behavior of the adolescent participants themselves, it used a patient-oriented perspective, whereby the adolescents reported more discussions with their doctors.
“Our results suggest that the HIT technology appears to have helped facilitate those crucial face-to-face conversations between providers and their teen patients about mental and emotional health issues,” said Thompson, associate professor in the Department of Pediatrics at UF. “Given that recommendations for health risk assessment are standard policy from the American Academy of Pediatrics, the Society for Adolescent Health and Medicine, and the American Medical Association, this feasibility study seems to reduce known barriers to screening in the primary care setting, allowing a broader, systematic, standardized and confidential means of implementing health risk assessments in a clinical setting.”
Learn more about how Thompson’s innovative efforts to protect the confidentiality of adolescent patients via online portals garnered attention from the Journal of Adolescent Health in a recent editorial here.