South Texas Psychiatric PBRN Pilot Study to Develop & Evaluate the South Texas Psychiatric PBRN’s Session Conversation Starter (SCS) Tablet-Based Agenda Setting Tool to Enhance Psychiatric Follow-up Visits.

What is a PBRN? A PBRN is a group of 15 to several hundred healthcare practices devoted primarily to the care of patients. These practices are united by a shared commitment to expand the science base of clinical care through systematic inquiry to better understand the health and health care events that unfold daily in their community practice settings.

Who is the South Texas Psychiatric PBRN The South Texas Psychiatric PBRN is an organization of community clinicians who collaborate together with UTHSCSA researchers to answer meaningful questions that will improve practice and patient care. Network is composed of 72 individual Psychiatrist in and around South Texas. PBRNs have been recognized as excellent tools for conducting a variety of research activities in primary care.

How is a Card Study used? Clinicians complete the card at the time of the visit. Ideally, the card should be small enough to fit in your pocket Allows clinician to carry it with them and use it during or after a medical consult. Card studies allow clinicians and practices to compile large samples quickly with reasonable burden.

IIMS CE GRANT AWARD: Background Title: Pilot Study to Develop & Evaluate the South Texas Psychiatric PBRN’s Session Conversation Starter Tablet-Based Agenda Setting Tool (SCS TBAST) to Enhance Psychiatric Follow-up visits. TECHNOLOGY USED IN CLINICAL PRACTICE: The use of electronic devices to assist in clinical management of medically ill patients has gained widespread interest and use (Heron & Smyth, 2010; Forchuk, Donelle, Ethridge & Warner, 2015). Electronic devices such as smartphones/tablets and wearable programmable devices have been developed to monitor a variety of patient physiological and psychological variables of clinical usefulness, but typically their use has been restricted to primary care settings

Background: Continued… AGENDA SETTING: The Affordable Care Act has encouraged providers to involve patients as proactive participants in maintaining their own good health, by effectively managing their chronic disease and engaging in shared decision making with their physicians. Patient activation requires the patient to be involved in the decision making process of their own treatment and insists that the patient has the knowledge, skills, and confidence needed to manage one's own health.

Project Objectives and Specific Aims SPECIFIC AIMS: To promote collaborative decision-making between psychiatrists and their patients by testing an agenda-setting tool for patient activation. Objectives: Collaboratively modify a tablet-based electronic application for patient agenda setting with PBRN members so that it is culturally-relevant; Implement the inclusion of the electronic application during check-in, in which patients well help to set the agenda of their visit; Provide the psychiatrist with immediate, patient-formulated agendas for the assessment of their patients; Evaluate the effectiveness and clinical usefulness of the electronic application among participating psychiatrists and satisfaction for the psychiatrist and patient.

How the project came to life… The purpose of this pilot project is to address a real world problem encountered by many psychiatrists, patients withholding topics of concern till the last minute of a psychiatric appointment. This issue was identified by fellow psychiatrist at one of our quarterly Psychiatry PBRN meetings. Through discourse it was decided that with the assistance of a implemented tablet-based agenda setting tool, that we would develop a method for patients to outline the agenda of each visit before prior to the start of their session.

Significance: This study is being conducted by the Psychiatric PBRN in collaboration with EvaluTrac LLC to develop and test Session Conversation Starter tablet-based agenda setting tool (SCS TBAST) in the clinical setting. The SCS TBAST will allow the patient to flag important issues or concerns prior to the start of their session that is important for them to be addressed. This project aims to integrate technology into the clinical setting by administering an agenda setting tool to assist the psychiatrist and patient in the course of their treatment plan.

Methods: The project will distribute 5 tablets in two month waves to 5 PBRN member practices (N=10 Psychiatrists). Psychiatrists will be expected to use the device for 2 months with all consecutive follow-up patients that volunteer to participate in the project. Estimated Patient enrollment for each psychiatrist is 20+ patients.

Methods Cont.: Three surveys will be administered to evaluate the effectiveness and overall satisfaction of the patient-doctor interface: Pre-Patient Questionnaire: (To be filled out before using the SCS TBAST) consists of 6 questions regarding: Gender Age Patient’s previous experience with psychiatrist covering all topics of discussion, Withholding concerns Overall satisfaction

Methods Cont.: Post-Patient Questionnaire: (To be filled out at the end of the follow-up visit) consist of three questions focused on: Ease of use for the SCS TBAST Psychiatrist covered all of their concerns overall satisfaction

Methods Cont.: Psychiatrist Survey: (To be filled out at the end of the follow-up visit) consist of six questions focused on: Diagnosis Patient difficulty Availability of TBAST results Time needed to review results Helpfulness of information generated Overall satisfaction

Expected Findings: We anticipate that this project will promote collaborative decision-making between psychiatrist and their patients by using the SCS TBAST for patient activation. Our anticipated results are that psychiatrists will report: A simplified implementation process for the SCS TBAST, A more efficient follow-up visit resulting in a decline of patient-withheld concerns at the end of their sessions, Improved satisfaction for both patient and psychiatrist, and Overall improved patient outcomes.

Conclusion: Next Steps We are currently in the process of recruiting more psychiatrists for the project. April 2016 is our expected start date. We expect to use the SCS TBAST with over two hundred patients within the following year. The South Texas Psychiatric PBRN members participating in this project will provide exit interviews with their views and suggestions for improving technology like this in the clinical setting for future purposes. We hope to be able to distribute this product to other psychiatrists who may need assistance in developing physician-patient collaborative decision-making.