Effectiveness and Clinical Usefulness of Electronic Agenda Setting

Effectiveness and Clinical Usefulness of Electronic Agenda Setting

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.

Background/Significance
There is general consensus that the doctorpatient 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 previsit 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

Figure 1: Patient Demographics
Site

Gender
Age
(Mean: 45 y.o.)

Race / Ethnicity

Diagnosis

N = 138

Percent

Private Clinic

105

76%

UTHSCSA Bipolar Clinic

17

12%

UHS HIV Clinic

16

12%

Male

58

42%

Female

80

58%

18-34

41

30%

35-54

61

44%

55+

36

26%

White

90

65%

Hispanic

25

18%

African American

2

1.5%

Asian

2

1.5%

Mixed Race

5

4%

Undisclosed

14

10%

MDD/Dysthymia

80

58%

Panic/GAD/OCD/SAD

60

44%

Bipolar Disorder

36

26%

Personality Disorder

10

7%

PTSD

6

4%

ADHD/Impulse Control

15

11%

Cognitive Disorder

7

5%

Eating Disorder

5

4%

Schizophrenia

4

3%

Alcohol/Substance

17

12%

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 postvisit 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 postvisit 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
Patients 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
Overall satisfaction
Psychiatrist Questionnaire consisted of 6
questions regarding:
Diagnosis
Patient difficulty
Availability of agenda setting results
Time needed to review results
Helpfulness of information generated
Overall satisfaction

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.
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)

Figure 2: Paired Samples t-test Means Comparisons
4

*p<.05 **p<.001 3.9 3.88 3.8 3.7 3.7 3.66 3.6 3.56 3.5 3.4 Patient Concerns Addressed* Pre-Visit Group Mean Patient Satisfaction** Post-Visit Group Mean Figure 2a: Paired Samples t-tests Means Comparisons Patient Concerns Addressed Patient Satisfaction Pre-Visit Group SD Post-Visit Group SD Mean Difference (SD) 95% Confidence Interval (CI) Range .616 .657 .138 (.794) .271 to .004 .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 doctorpatient 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. References 1. Willliams S, Weinman J, Dale J. Doctor-patient communication and patient satisfaction: a review. Family Practice 1998; 15: 480-92. 2. 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: 1361-7. 3. 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: 520-6. 4. Channon S, Huws-Thomas M, Gregory J, Rollnick S. Motivational interviewing with teenagers with diabetes. Clin Child Psychol Psychiatry 2005; 10: 43-51. 5. Manning P, Ray GB. Setting the agenda: an analysis of negotiation strategies in clinical talk. Health Commun 2002; 14: 451-73. 6. 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: 822-9. 7. 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: 1317-23.

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