Cargando…
Electronic Health Risk Behavior Screening With Integrated Feedback Among Adolescents in Primary Care: Randomized Controlled Trial
BACKGROUND: Health risk behaviors are the most common sources of morbidity among adolescents. Adolescent health guidelines (Guidelines for Preventive Services by the AMA and Bright Futures by the Maternal Child Health Bureau) recommend screening and counseling, but the implementation is inconsistent...
Autores principales: | , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
JMIR Publications
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7998326/ https://www.ncbi.nlm.nih.gov/pubmed/33709942 http://dx.doi.org/10.2196/24135 |
_version_ | 1783670526646943744 |
---|---|
author | Richardson, Laura Parker, Elizabeth Oshrin Zhou, Chuan Kientz, Julie Ozer, Elizabeth McCarty, Carolyn |
author_facet | Richardson, Laura Parker, Elizabeth Oshrin Zhou, Chuan Kientz, Julie Ozer, Elizabeth McCarty, Carolyn |
author_sort | Richardson, Laura |
collection | PubMed |
description | BACKGROUND: Health risk behaviors are the most common sources of morbidity among adolescents. Adolescent health guidelines (Guidelines for Preventive Services by the AMA and Bright Futures by the Maternal Child Health Bureau) recommend screening and counseling, but the implementation is inconsistent. OBJECTIVE: This study aims to test the efficacy of electronic risk behavior screening with integrated patient-facing feedback on the delivery of adolescent-reported clinician counseling and risk behaviors over time. METHODS: This was a randomized controlled trial comparing an electronic tool to usual care in five pediatric clinics in the Pacific Northwest. A total of 300 participants aged 13-18 years who attended a well-care visit between September 30, 2016, and January 12, 2018, were included. Adolescents were randomized after consent by employing a 1:1 balanced age, sex, and clinic stratified schema with 150 adolescents in the intervention group and 150 in the control group. Intervention adolescents received electronic screening with integrated feedback, and the clinicians received a summary report of the results. Control adolescents received usual care. Outcomes, assessed via online survey methods, included adolescent-reported receipt of counseling during the visit (measured a day after the visit) and health risk behavior change (measured at 3 and 6 months after the visit). RESULTS: Of the original 300 participants, 94% (n=282), 94.3% (n=283), and 94.6% (n=284) completed follow-up surveys at 1 day, 3 months, and 6 months, respectively, with similar levels of attrition across study arms. The mean risk behavior score at baseline was 2.86 (SD 2.33) for intervention adolescents and 3.10 (SD 2.52) for control adolescents (score potential range 0-21). After adjusting for age, gender, and random effect of the clinic, intervention adolescents were 36% more likely to report having received counseling for endorsed risk behaviors than control adolescents (adjusted rate ratio 1.36, 95% CI 1.04 to 1.78) 1 day after the well-care visit. Both the intervention and control groups reported decreased risk behaviors at the 3- and 6-month follow-up assessments, with no significant group differences in risk behavior scores at either time point (3-month group difference: β=−.15, 95% CI −0.57 to −0.01, P=.05; 6-month group difference: β=−.12, 95% CI −0.29 to 0.52, P=.57). CONCLUSIONS: Although electronic health screening with integrated feedback improves the delivery of counseling by clinicians, the impact on risk behaviors is modest and, in this study, not significantly different from usual care. More research is needed to identify effective strategies to reduce risk in the context of well-care. TRIAL REGISTRATION: ClinicalTrials.gov NCT02882919; https://clinicaltrials.gov/ct2/show/NCT02882919 |
format | Online Article Text |
id | pubmed-7998326 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | JMIR Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-79983262021-04-01 Electronic Health Risk Behavior Screening With Integrated Feedback Among Adolescents in Primary Care: Randomized Controlled Trial Richardson, Laura Parker, Elizabeth Oshrin Zhou, Chuan Kientz, Julie Ozer, Elizabeth McCarty, Carolyn J Med Internet Res Original Paper BACKGROUND: Health risk behaviors are the most common sources of morbidity among adolescents. Adolescent health guidelines (Guidelines for Preventive Services by the AMA and Bright Futures by the Maternal Child Health Bureau) recommend screening and counseling, but the implementation is inconsistent. OBJECTIVE: This study aims to test the efficacy of electronic risk behavior screening with integrated patient-facing feedback on the delivery of adolescent-reported clinician counseling and risk behaviors over time. METHODS: This was a randomized controlled trial comparing an electronic tool to usual care in five pediatric clinics in the Pacific Northwest. A total of 300 participants aged 13-18 years who attended a well-care visit between September 30, 2016, and January 12, 2018, were included. Adolescents were randomized after consent by employing a 1:1 balanced age, sex, and clinic stratified schema with 150 adolescents in the intervention group and 150 in the control group. Intervention adolescents received electronic screening with integrated feedback, and the clinicians received a summary report of the results. Control adolescents received usual care. Outcomes, assessed via online survey methods, included adolescent-reported receipt of counseling during the visit (measured a day after the visit) and health risk behavior change (measured at 3 and 6 months after the visit). RESULTS: Of the original 300 participants, 94% (n=282), 94.3% (n=283), and 94.6% (n=284) completed follow-up surveys at 1 day, 3 months, and 6 months, respectively, with similar levels of attrition across study arms. The mean risk behavior score at baseline was 2.86 (SD 2.33) for intervention adolescents and 3.10 (SD 2.52) for control adolescents (score potential range 0-21). After adjusting for age, gender, and random effect of the clinic, intervention adolescents were 36% more likely to report having received counseling for endorsed risk behaviors than control adolescents (adjusted rate ratio 1.36, 95% CI 1.04 to 1.78) 1 day after the well-care visit. Both the intervention and control groups reported decreased risk behaviors at the 3- and 6-month follow-up assessments, with no significant group differences in risk behavior scores at either time point (3-month group difference: β=−.15, 95% CI −0.57 to −0.01, P=.05; 6-month group difference: β=−.12, 95% CI −0.29 to 0.52, P=.57). CONCLUSIONS: Although electronic health screening with integrated feedback improves the delivery of counseling by clinicians, the impact on risk behaviors is modest and, in this study, not significantly different from usual care. More research is needed to identify effective strategies to reduce risk in the context of well-care. TRIAL REGISTRATION: ClinicalTrials.gov NCT02882919; https://clinicaltrials.gov/ct2/show/NCT02882919 JMIR Publications 2021-03-12 /pmc/articles/PMC7998326/ /pubmed/33709942 http://dx.doi.org/10.2196/24135 Text en ©Laura Richardson, Elizabeth Oshrin Parker, Chuan Zhou, Julie Kientz, Elizabeth Ozer, Carolyn McCarty. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 12.03.2021. https://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included. |
spellingShingle | Original Paper Richardson, Laura Parker, Elizabeth Oshrin Zhou, Chuan Kientz, Julie Ozer, Elizabeth McCarty, Carolyn Electronic Health Risk Behavior Screening With Integrated Feedback Among Adolescents in Primary Care: Randomized Controlled Trial |
title | Electronic Health Risk Behavior Screening With Integrated Feedback Among Adolescents in Primary Care: Randomized Controlled Trial |
title_full | Electronic Health Risk Behavior Screening With Integrated Feedback Among Adolescents in Primary Care: Randomized Controlled Trial |
title_fullStr | Electronic Health Risk Behavior Screening With Integrated Feedback Among Adolescents in Primary Care: Randomized Controlled Trial |
title_full_unstemmed | Electronic Health Risk Behavior Screening With Integrated Feedback Among Adolescents in Primary Care: Randomized Controlled Trial |
title_short | Electronic Health Risk Behavior Screening With Integrated Feedback Among Adolescents in Primary Care: Randomized Controlled Trial |
title_sort | electronic health risk behavior screening with integrated feedback among adolescents in primary care: randomized controlled trial |
topic | Original Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7998326/ https://www.ncbi.nlm.nih.gov/pubmed/33709942 http://dx.doi.org/10.2196/24135 |
work_keys_str_mv | AT richardsonlaura electronichealthriskbehaviorscreeningwithintegratedfeedbackamongadolescentsinprimarycarerandomizedcontrolledtrial AT parkerelizabethoshrin electronichealthriskbehaviorscreeningwithintegratedfeedbackamongadolescentsinprimarycarerandomizedcontrolledtrial AT zhouchuan electronichealthriskbehaviorscreeningwithintegratedfeedbackamongadolescentsinprimarycarerandomizedcontrolledtrial AT kientzjulie electronichealthriskbehaviorscreeningwithintegratedfeedbackamongadolescentsinprimarycarerandomizedcontrolledtrial AT ozerelizabeth electronichealthriskbehaviorscreeningwithintegratedfeedbackamongadolescentsinprimarycarerandomizedcontrolledtrial AT mccartycarolyn electronichealthriskbehaviorscreeningwithintegratedfeedbackamongadolescentsinprimarycarerandomizedcontrolledtrial |