Electronic Health Risk Behavior Screening With Integrated Feedback Among Adolescents in Primary Care: Randomized Controlled Trial.

Laura Richardson,Carolyn Mccarty,Julie Kientz,Elizabeth Oshrin Parker,Chuan Zhou,Elizabeth Ozer

doi:10.2196/24135

Abstract

BackgroundHealth risk behaviors are the most common sources of morbidity among adolescents. Adolescent health guidelines (Guidelines for Preventive Services by the AMA and Bright Futures by the Maternal Child Health Bureau) recommend screening and counseling, but the implementation is inconsistent.ObjectiveThis study aims to test the efficacy of electronic risk behavior screening with integrated patient-facing feedback on the delivery of adolescent-reported clinician counseling and risk behaviors over time.MethodsThis was a randomized controlled trial comparing an electronic tool to usual care in five pediatric clinics in the Pacific Northwest. A total of 300 participants aged 13-18 years who attended a well-care visit between September 30, 2016, and January 12, 2018, were included. Adolescents were randomized after consent by employing a 1:1 balanced age, sex, and clinic stratified schema with 150 adolescents in the intervention group and 150 in the control group. Intervention adolescents received electronic screening with integrated feedback, and the clinicians received a summary report of the results. Control adolescents received usual care. Outcomes, assessed via online survey methods, included adolescent-reported receipt of counseling during the visit (measured a day after the visit) and health risk behavior change (measured at 3 and 6 months after the visit).ResultsOf the original 300 participants, 94% (n=282), 94.3% (n=283), and 94.6% (n=284) completed follow-up surveys at 1 day, 3 months, and 6 months, respectively, with similar levels of attrition across study arms. The mean risk behavior score at baseline was 2.86 (SD 2.33) for intervention adolescents and 3.10 (SD 2.52) for control adolescents (score potential range 0-21). After adjusting for age, gender, and random effect of the clinic, intervention adolescents were 36% more likely to report having received counseling for endorsed risk behaviors than control adolescents (adjusted rate ratio 1.36, 95% CI 1.04 to 1.78) 1 day after the well-care visit. Both the intervention and control groups reported decreased risk behaviors at the 3- and 6-month follow-up assessments, with no significant group differences in risk behavior scores at either time point (3-month group difference: β=−.15, 95% CI −0.57 to −0.01, P=.05; 6-month group difference: β=−.12, 95% CI −0.29 to 0.52, P=.57).ConclusionsAlthough electronic health screening with integrated feedback improves the delivery of counseling by clinicians, the impact on risk behaviors is modest and, in this study, not significantly different from usual care. More research is needed to identify effective strategies to reduce risk in the context of well-care.Trial RegistrationClinicalTrials.gov NCT02882919; https://clinicaltrials.gov/ct2/show/NCT02882919

Highlights

BackgroundHealth risk behaviors, such as alcohol use, risky sexual behaviors, and low physical activity, are among the most common causes of morbidity and mortality during adolescence and young adulthood [1,2]
145 patients were randomized to the intervention group and 155 to the control group
In the Poisson regression analyses, intervention adolescents were significantly more likely to report that they had received counseling for their endorsed moderate- and high-risk behaviors than control adolescents

Summary

Introduction

BackgroundHealth risk behaviors, such as alcohol use, risky sexual behaviors, and low physical activity, are among the most common causes of morbidity and mortality during adolescence and young adulthood [1,2]. To reduce risk and morbidity, adolescent preventive care guidelines recommend screening and counseling to reduce these behaviors as a component of annual well-care visits [3,4]. Few studies have examined the impact of increasing clinician counseling on adolescent behavior outcomes in the context of multi-risk screening, as is commonly performed in well-care visits. In a recent review article examining multi-risk screening in adolescents, 9 studies were identified, with some demonstrating effects on risk behaviors [7]. Among these trials, variations in intervention duration, intensity, behaviors studied, and impacted outcomes led to a limited ability to draw definitive conclusions. Adolescent health guidelines (Guidelines for Preventive Services by the AMA and Bright Futures by the Maternal Child Health Bureau) recommend screening and counseling, but the implementation is inconsistent

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Results

Discussion

Conclusion