Screening While You Wait (SWYW); Technology-based, Patient-initiated health practice screening in primary care waiting rooms

Mental Health, Children and Community Care


Noah Ivers

noah.ivers@wchospital.ca

416-323-6400 x5210

WCH Academic and Medical Services Group; WCH; UofT

Highlights

WCH-16-004 We created an automated process to assess and address physical activity levels within routine primary care. A tailored algorithm for each patient created: (1) a customized exercise prescription in the patient EMR, and (2) a personalized, printable toolkit with online and local resources to increase physical activity. Toolkits were tailored based on level of activity, the patient’s intention and self-efficacy for exercise, and their co-morbidities. Process evaluations from this pilot trial, indicated that patients who received the intervention were satisfied with their physical activity discussion with their physician. This pilot trial indicates a potential role for tailored e-Health resources informed by patient-reported measures in primary care and helped to identify the challenges that must be addressed with the implementation of such e-Health interventions.

Abstract

WCH-16-004 Background: Only 18% of Canadians meet physical activity (PA) guidelines despite known benefits for mortality and well-being. Guidelines recommend that clinicians provide advice about PA during routine visits, but this is rarely implemented. We evaluated the feasibility and preliminary effectiveness of a technology-based PA counselling tool in primary care. Methods: A pilot step-wedge randomized trial was conducted at an urban academic family practice. The intervention was sequentially administered, with one of four teams of clinicians switching from usual care to the intervention every 6-weeks, until all were exposed. Eligible patients received an e-survey prior to their appointment to assess PA levels and beliefs. Survey results were used to automatically populate the chart with a tailored prescription and educational resources. PA was reassessed after four months; secondary outcomes include changes in intention and self-efficacy. Process measures included patient satisfaction with PA advice, receiving the toolkit and prescription, and time spent on PA counselling. Results: Of 530 eligible patients, 82.5% provided baseline and follow-up data. PA (Metabolic Equivalent of Task minutes/week) in the intervention group was 10% greater than controls (count ratio, 1.10, 95% CI 0.86-1.41, p=0.44). After adjusting for baseline covariates, the effect of the intervention remained non-significant. 61.8% of patients exposed to the intervention completed a process evaluation; of these patients, 49.4% reported receiving at least a prescription, 48.9% reported spending 2-5 minutes discussing PA with their provider, and 86.8% reported being satisfied with the discussion. Conclusion: The introduction of an e-Health tool for PA was feasible to implement in a large practice and resulted in a non-statistically significant increase in PA.

Themes & Abstracts

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