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
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