1. Effectiveness and Clinical Usefulness of Electronic Agenda Setting in Psychiatric Practices: A South Texas Psychiatric PBRN Study
Cervando Martinez Jr., M.D and Jennifer Daniels, B.A.
Figure 1: Patient Demographics
Background/Significance
N = 138
Percent
Site
Private Clinic
105
76%
UTHSCSA – Bipolar Clinic 17
12%
UHS – HIV Clinic 16
Gender
Male 58
42%
Female 80
58%
Age
(Mean: 45 y.o.)
18-34 41
30%
35-54 61
44%
55+ 36
26%
Race / Ethnicity
White 90
65%
Hispanic 25
18%
African American 2
1.5%
Asian
Mixed Race 5 4%
Undisclosed 14
10%
Diagnosis
MDD/Dysthymia
Panic/GAD/OCD/SAD 60
Bipolar Disorder
Personality Disorder 10 7%
PTSD 6
ADHD/Impulse Control 15
11%
Cognitive Disorder 7 5%
Eating Disorder
Schizophrenia 4 3%
Alcohol/Substance
There is general consensus that the doctor-patient interview should be as productive, “satisfying”, and efficient as possible.1 Several techniques to accomplish this have evolved in recent years: shared decision making,2 patient activation,3 motivational interviewing,4 agenda setting5 and others.6,7 Many of these techniques have been developed in primary care and specialty medical settings as well as in psychiatric ones. Electronic aids in medicine, from electronic medical records to apps, have become ever-present in the clinical setting.
Study Aims:
To facilitate shared decision making between psychiatrist and patient via pre-visit patient agenda setting
To investigate the usefulness and feasibility of using an electronic tablet to assist the patient in setting the agenda for the psychiatric clinical visit
Methods
This study was conducted with the South Texas Psychiatric PBRN (STX Psych PBRN), a practice-based research network of outpatient psychiatric clinics in the South Texas area. Medical office staff and one research assistant recruited 141 patients from seven STX Psych PBRN clinics. Cross-sectional data were gathered from patients using pre-visit and post-visit paper-based questionnaires, as well as via the electronic tablet which was used to set the patient agenda. In addition, cross-sectional data were gathered from psychiatrists using a post-visit paper-based questionnaire. Usefulness and feasibility were assessed using rating scales developed by the STX Psych PBRN, which measured patient satisfaction and concerns addressed before and after visit, as well as ease of use for patient, psychiatrist satisfaction, and clinical helpfulness.
Pre-Visit Patient Questionnaire consisted of 6 questions regarding:
Gender
Age
Patient’s previous experience with psychiatrist covering all topics of discussion
Withholding concerns
Overall satisfaction
Post-Visit Patient Questionnaire consisted of 3 questions regarding:
Ease of use of the electronic device
Psychiatrist coverage of their concerns during this visit
Psychiatrist Questionnaire consisted of 6 questions regarding:
Diagnosis
Patient difficulty
Availability of agenda setting results
Time needed to review results
Helpfulness of information generated
*p<.05
**p<.001
Figure 2a: Paired Samples t-tests Means Comparisons
Pre-Visit Group SD
Post-Visit Group SD
Mean Difference (SD)
95% Confidence Interval (CI) Range
Patient
Concerns Addressed
.616
.657
.138 (.794)
.271 to .004
Patient Satisfaction
.598
.409
.217 (.550)
.310 to .125
Conclusions
The project supports the potential use of this type of office-based technology in order to enhance the doctor-patient interaction. This electronic tablet based agenda setting tool, developed in collaboration with our community partner EvaluTrac LLC, was found relatively easy to use by a sample of psychiatric patients who also felt it enhanced their satisfaction with the visit. The psychiatrists, likewise, found the tool relatively helpful and were generally satisfied with the visit. It is possible other medical specialties could also develop appropriate content for a similar tool to be used in their practices that might also enhance their clinical work. We hope our work will encourage others to use this tool in their practices for furtherance of better patient care.
Results/Findings
Of the 141 patients recruited, post-visit data were collected for 138. Demographic information collected is listed in Figure 1, paired samples t-tests means comparisons are listed in Figures 2 and 2a, and post-visit responses for both patient and psychiatrist are listed in Figure 3.
References
Willliams S, Weinman J, Dale J. Doctor-patient communication and patient satisfaction: a review. Family Practice 1998; 15:
Elwyn G, Frosch D, Thomson R, Joseph-Williams N, Lloyd A, Kinnersley P, et al. Shared Decision Making: A Model for Clinical Practice. J Gen Intern Med 2012; (27)10:
Greene J, Hibbard J. Why does patient activation matter? An examination of the relationships between patient activation and health-related outcomes. J Gen Intern Med 2012; 27:
Channon S, Huws-Thomas M, Gregory J, Rollnick S. Motivational interviewing with teenagers with diabetes. Clin Child Psychol Psychiatry 2005; 10:
Manning P, Ray GB. Setting the agenda: an analysis of negotiation strategies in clinical talk. Health Commun 2002; 14:
Gobat N, Kinnersley P, Gregory J, Robling M. What is agenda setting in the clinical encounter? Consensus from literature review and expert consultation. Patient Education and Counseling 2015; 98:
Brock DM, Mauksch LB, Witteborn S, Hummel J, Nagasawa P, Robins LS. Effectiveness of intensive physician training in upfront agenda setting. J Gen Intern Med 2011; 26:
Figure 3: Post-Visit Responses
Post-visit Mean Scores
Ease of Use of Electronic Device – Patient Rating
1.25 (1-5, 1 Very Easy)
Helpfulness of Electronic Device – Patient Rating
.82 (0-1, 1 Helpful)
Helpfulness of Electronic Device – Psychiatrist Rating
2.77 (0-4, 2 Useful / 4 Very Useful)
Psychiatrist Satisfaction
3.71 (0-4, Very Satisfied)