Real-world setting supports clinical value
“One of the strengths of our study is that the mPATH app was delivered as usual care in the primary care clinics,” Dr. Miller said in an interview. “In other words, we relied entirely on clinical staff to hand the app to patients and transmit the screening results to the electronic health record. This allowed us to see how self-administered screening performs in the real world rather than in a research setting,” he said. “Another strength is our large sample size. We included more than 23,000 patients who were seen at one of six community-based primary care practices.”
“A few other studies have compared electronic self-administered screening with verbal screening, mainly in the areas of intimate partner violence or sexual health,” Dr. Miller noted. “However, these studies were administered by research staff and only included patients agreeing to be in a research study, which leaves many people out. What makes our study unique is that the primary care practices were using the self-screening app as part of their routine care,” he said.
“By analyzing deidentified data, we could see how self-administered screening compares to verbal screening among all patients in a real-world setting,” he added.
“We found that self-administered screening significantly outperforms verbal screening by clinical staff. Over twice as many patients with depression, fall risk, or intimate partner violence were identified by the app, compared to verbal screening,” said Dr. Miller. “We hope that clinics will look for ways to incorporate electronic self-screening in their usual processes. Self-administered screening not only saves staff time, but it does a much better job identifying patients with needs,” he said.
“The next step will be identifying the best way to incorporate digital health apps like mPATH into usual workflows,” Dr. Miller said. “We are currently conducting an implementation science trial of the mPATH app to learn this.”
App allows patients privacy in responses
“The study is important for assessing the physical and mental well-being of patients at all health care practices in general and in primary care practices in particular, said Noel Deep, MD, a general internist in group practice in Antigo, Wisc., in an interview. “This study provides the data that can be leveraged to provide this type of virtual or electronic options for patients to answer these sensitive questions,” he said.
“It provides them the opportunity to answer the questions truthfully and without fear of being judged by the staff who traditionally ask these questions,” he emphasized.
Dr. Deep was not surprised by the study outcomes.
“Almost all primary care practices administer these questionnaires to their patients, whether at their annual wellness exams or the Medicare wellness exams,” he said. “Many times, the staff asking these questions might introduce some of their personal bias or not ask the questions in a nonjudgmental manner, which may not elicit the right answers from the patients.”
The clinical value of the study is that it prompts physicians and health care organizations to consider adopting other modalities to collect screening information “that is comfortable to the patients, reproducible, patient-friendly, easily accessed by the patients and reviewable by their physicians, and, more importantly is private and maintains patient confidentiality,” said Dr. Deep.
Study needs to be replicated in rural, small communities
“I would like to see the study done among more diverse ethnic, age, socioeconomic, education, geographic, and physician practice–size populations,” which would reinforce the value of the tablet-based app if such studies yielded similar results, Dr. Deep said.
Privacy is especially important for practices in smaller communities/rural communities, such as the one where Dr. Deep practices, as everyone knows everyone in these kinds of places, he said.
“I understand that we are all sworn to maintaining patient confidentiality, but that may not be what the patients perceive. That is why I would like to see what the study finds in rural or small communities,” Dr. Deep explained.
The study was supported by the National Cancer Institute. Dr. Miller and coauthor Dr. Ajay Dharod are the coinventors of the mPATH app, and they and Wake Forest University Health Sciences have an ownership interest should the app be commercialized. Dr. Deep had no financial conflicts to disclose.