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Page 15
Arch Gen Intern Med 2017 | Volume 1 Issue 3
allied
academies
International Conference on
FAMILY MEDICINE AND FAMILY PHYSICIANS
October 16-17, 2017 | Toronto, Canada
Background: Access to timely care for common mental
disorders is an on-going challenge, especially for vulnerable
ethno-cultural and immigrant groups. With the aim to address
such challenges for populations served by community health
centres (CHCs), our team developed an interactive computer-
assisted client assessment survey (iCCAS) tool for pre-consult
assessment of commonmental disorders of depression, anxiety,
post-traumatic stress disorder and alcohol abuse (using PHQ9,
GAD7, PTSD-PC and CAGE) along with questions on social
determinants of health. Patients completed the assessment
in their waiting time and the program generated point-of-care
reports.
Methods: A pilot randomized controlled trial recruited
(response rate 78%) adult patients, fluent in English or Spanish,
and seeing a physician or nurse practitioner at the partnering
CHC in Toronto. The trial objectives were to examine the
interventions’ efficacy in improving mental health discussion
(primary) and symptom detection (secondary). The trial data
were collected by a paper-pencil exit survey and chart review.
We also conducted post-trial qualitative interviews with
clinicians and with a subset of screen-positive patients.
Results: iCCAS (n=75) and usual care (n=72) groups were
similar in socio-demographics; 98% were immigrants and 68%
females. Mental health discussion occurred for 58.7% in iCCAS
and 40.3% in the usual care group (p<0.05); the effect remained
significant while controlling for potential covariates (language,
gender, education, employment) in Generalized Linear Mixed
Model, GLMM (Adj OR 2.2; 95% CI: 1.1-4.5). Mental health
symptom detection occurred for 38.7% in iCCAS and 27.8% in
usual care group (p>0.05); the effect was not significant beyond
potential covariates in GLMM (Adj OR 1.9; 95% CI: 0.9-4.1).
Patients using the iCCAS reported its completion time was
acceptable (94.5%), the touch-screen was easy to use (97.3%),
and the instructions (93.2%) and questions (94.6%) were clear.
The qualitative interviews with nine participating clinicians
showed their positive experiences: tool’s benefits (e.g., non-
intrusive prompting of clients to discuss mental health, and
facilitation of clinicians’ assessment and care plans); tool’s
integration into everyday practice; and promoting integration
effectively (e.g., settings readiness, language diversity, and EMR
linkages). Further, the need for routine screening at the CHCs
was supported by the high rates of CMDs found via iCCAS: 36%
reported symptoms of moderate to severe depression (PHQ9
score>10); 17.7% reported moderate to severe symptoms
for anxiety (GAD7 score >10); 28.4% had symptoms for post-
traumatic stress (PTSD-PC>3). The follow-up qualitative
interviews with a subset of screen-positive patients identified
improved care quality of care via new detection of CMDs or co-
morbidity or possible relapse.
Interpretation: The studied intervention holds potential for
CHCs to improve mental health discussion, detections and
quality of care. Further research with larger sample and
inclusion of multiple sites is needed to enhance generalizability..
Speaker Biography
Farah Ahmad, MBBS, MPH, PhD is an Associate Professor at the School of Health Policy
and Management, York University and affiliate Research Scientist at the North York
General Hospital. Her training includes family medicine and public health sciences.
She conducts health services research with a focus on psychosocial health vulnerable
communities, primary care and eHealth innovations. She has extensively published in
the areas of underserved populations, mental health and partner violence.
e:
Farah Ahmad
York University, Canada
Bringing interactive eHealth tools to community health centers for assessment of
common mental disorders