“Anyone who has been to a doctor’s office recently realizes that everyone there is very busy,” said David P. Miller Jr., MD, lead author of the paper published in JAMA Network Open, in an interview. “For our study, we programmed routine screening questions that nursing staff were asking at every visit into an app [called mPATH] that patients used on check-in.”
Dr. David P. Miller Jr.
In particular, screening for depression, injurious falls, or intimate partner violence in a primary care setting is hampered not only by time constraints, but also staff discomfort and patients’ reluctance to disclose sensitive information, Dr. Miller of Wake Forest University, Winston-Salem, N.C., and colleagues explained in their paper.
Study methods and results
The researchers tested the app in three family practices and three internal medicine practices. They compared whether more patients were identified with depression, intimate partner violence, or fall risk in the 60 days of using the tablet-based app, compared with the 60-day period before introduction of the app, when nursing staff asked screening questions verbally. Patients were given the tablet and app to use at check-in, and results went into an electronic health record.
The study population included 23,026 individuals, aged 18 years and older who were seen between June 2019 and February 2020.
The post-app period was shortened to 30 days for the last two enrolled practices to avoid confounding from COVID-19, the researchers noted.
The primary outcome of the study was the proportion of patients who screened positive for a composite of depression, fall risk, or intimate partner violence.
“We found that [the app] significantly outperformed nursing staff in terms of detecting patients with depression or safety concerns,” Dr. Miller said in an interview. “By saving nurses time, we hope they can use the saved time to address patients’ identified concerns.”
Overall, the proportion of patients who screened positive for the composite outcome of depression, fall risk, or intimate partner violence increased from 8.7% to 19.5%. Increases were noted across all six participating clinics.
When broken out separately, the proportion of patients who screened positive for depression, based on Patient Health Questionnaire-2 scores of 2 or higher, increased from 1.5% to 4.2% from before to after the introduction of the tablet-based app. The proportion of patients screening positive for fall risk increased from 7.4% to 15.7%, and the proportion who screened positive for intimate partner violence increased from 0.1% to 2.9%.
Patient demographics were similar for the two time periods. Overall, 57.9% of patients were female, 80.5% were non-Hispanic White, and 13.5% were Black or African American. Patients ranged in age from 18-102 years, with a mean age of 59.7 years.
The association of app use on the primary outcome remained the same (adjusted odds ratio, 2.6) after accounting for patient characteristics.