Electronic questionnaire helps primary care practices collect health info on teens
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Key takeaways:
- Researchers developed and tested an adolescent heath questionnaire at dozens of primary care practices.
- The questionnaire improved the collection of information about patients’ strengths and vulnerabilities.
Researchers developed an electronic health questionnaire for primary care practices that improves the collection of information about adolescents’ health behaviors, according to a study published in Pediatrics.
Adolescents at dozens of practices said they preferred to answer questions about their health, nutrition, safety, alcohol and tobacco use and sexual history — among other topics — using the electronic questionnaire, rather than face-to-face with their provider.
The project was meant to address several critical gaps in adolescent health care, one of the researchers told Healio.
“Few adolescents report ever being screened for risk behaviors or having a confidential discussion about these behaviors with their primary care clinician,” said Brian P. Jenssen, MD, MSHP, a researcher and primary care pediatrician at The Children’s Hospital of Philadelphia (CHOP).
“Despite consensus guidelines targeting and supporting adolescent screening and counseling at pediatric preventive care visits, rates of screening and discussions are low and have remained so over the past 3 decades,” Jenssen said.
According to Jennsen, major barriers to this type of screening include:
- adolescents’ concerns about confidentiality, which limit their disclosure of health risks;
- lack of clinician time; and
- limited pediatrician comfort and knowledge in screening for adolescent health risks and delivering adolescent health services.
“Innovative solutions were needed to successfully overcome these barriers to screening to better support adolescent-pediatrician discussions,” Jenssen said.
Patients preferred electronic questionnaire
Jenssen and a team that included pediatricians, clinical informaticists, pediatric health services researchers, EHR programmers and other experts developed and pilot-tested their own adolescent health questionnaire (AHQ) at one of CHOP’s care centers.
The AHQ, which was completed on a tablet, included questions about strengths — like working hard or having talents or skills — nutrition and physical activity, weapons, tobacco, substance use, sexual health, and other areas that young patients may be reluctant to bring up with their physician.
The researchers designed the system to summarize patients’ responses and add them to their EHRs to be documented and reviewed, and also to flag responses that need further discussion.
The researchers scaled the questionnaire to be used at 31 practices in the hospital’s primary care network from October 2020 to December 2021, and tested it based on several measures:
- reach: the total number of questionnaires completed;
- effectiveness: the capture of key information before and after the addition of the AHQ;
- adoption: how many practices adopted the AHQ;
- implementation: the proportion of adolescents who completed the AHQ; and
- maintenance: the rates of monthly completion.
During the 14 months in which the program was piloted and scaled in the 31 practices, 20,749 adolescents aged 13 to 21 years completed 22,147 questionnaires.
The researchers found that use of the AHQ increased collection of information on strengths (0% vs. 95%), nutrition (2% vs. 95%), physical activity (2% vs. 95%), school (94% vs. 97%), family and friends (0% vs. 95%), gun safety (1% vs. 93%), tobacco use (91% vs. 93%), alcohol and substance use (4% vs. 92%), sexual activity (25% vs. 92%), sexual orientation (6% vs. 92%) and gender identity (0% vs. 92%).
The researchers noted as an example that approximately 2% of adolescents reported using tobacco in the past year using a traditional face-to-face approach, whereas 6% of adolescents reported past-year tobacco use using the AHQ.
Among adolescents taking the questionnaire, 72% reported that they preferred to answer questions electronically compared with face to face.
‘We were surprised’
Ultimately, once scaling was finished, all 31 practices under observation adopted the AHQ, and 88.7% of adolescents had completed the questionnaire. At 2 years post scaling, completion rates were just over 91% per month, the researchers reported.
“We were surprised at how quickly our pediatricians across our diverse primary care network wanted to adopt this system,” Jenssen said. “We moved from pilot testing to scaling to all 31 practices in 2 years — during the peak of the COVID-19 pandemic. This speaks to how we really addressed a key problem with our solution — a standardized and systemized approach to facilitate adolescent health strength discussions and risk screening.”
Jenssen said the team is looking forward to assessing the impact of broad use of the AHQ on patient outcomes.
“In 2023, more than 59,000 individual teenagers at more than 95% of routine preventive care visits completed the AHQ,” Jenssen said. “This shows the sustainability and acceptance of our approach.”