Using a self-service kiosk to identify behavioural health needs in a primary care clinic serving an urban, underserved population

Fatima Kasiah,Glenda Wrenn,Irshad Syed

doi:10.14236/jhi.v22i3.134

Abstract

Integration of behavioural health into primary care clinics is an established model of care and important approach to eliminating mental health disparities, but demands on provider time is a barrier to mental health screening. The purpose of this study was to determine the feasibility of using a kiosk placed in a primary care clinic to screen for multiple mental health disorders. Quality improvement initiative with Plan-Do-Study-Act implementation and time series monitoring of utilisation outcomes. A total of 281 screens were completed identifying positive screens for depression (30%) and bipolar disorder (17%). Post-traumatic stress disorder and concerning substance use were less common. Development of health information technology to facilitate behavioural health assessment in primary care is a promising approach to integrated care and provides additional benefits of population health monitoring.

Highlights

Integration of behavioural health into primary care clinics is an established model of care and important approach to eliminating mental health disparities, but demands on provider time is a barrier to mental health screening
Routine screening for depression in primary care is recommended when staff-assisted supports are in place.[1]
Having self-service kiosks that patients can engage for ‘wellness assessment’ and screening for risky use of substances and highly prevalent mood disorders in primary care is both patient-centred and promotes efficiency in patient flow as patients spend valuable time waiting during the clinic visit

Summary

Introduction

Integration of behavioural health into primary care clinics is an established model of care and important approach to eliminating mental health disparities, but demands on provider time is a barrier to mental health screening. Conclusions Development of health information technology to facilitate behavioural health assessment in primary care is a promising approach to integrated care and provides additional benefits of population health monitoring. It has been 15 years since the 16th Surgeon General’s landmark report on mental health, which conveyed a central message that mental health is fundamental to health and that mental disorders are real health conditions. Relying on existing staff to interview patients is time consuming, and research has shown that patients are more likely to disclose sensitive information to a computer.[6] Freely available standardised, validated self-assessments exist that can accurately detect depression (Patient Health Questionnaire, PHQ-2 & PHQ-9), substance abuse (Drug Abuse Screening Test, DAST-10, Alcohol Use Disorders Identification Test, AUDIT10), risk for bipolar disorder (Mood Disorders Questionnaire, MDQ) and post-traumatic stress disorder (Posttraumatic Stress Disorder-Primary Care, PTSD-PC). Patients’ wait time can be used to collect important clinical information that providers could use to aid their decision-making and prioritisation of issues

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Results

Discussion

Conclusion