title: Integrating mental health into adolescent annual visits: impact of previsit comprehensive screening on within-visit processes.
abstract: OBJECTIVE
  To evaluate how a comprehensive, computerized, self-administered adolescent screener, the DartScreen, affects within-visit patient-doctor interactions such as data gathering, advice giving, counseling, and discussion of mental health issues.
  
  
  METHODS
  Patient-doctor interaction was compared between visits without screening and those with the DartScreen completed before the visit. Teens, aged 15-19 years scheduled for an annual visit, were recruited at one urban and one rural pediatric primary care clinic. The doctor acted as his/her own control, first using his/her usual routine for five to six adolescent annual visits. Then, the DartScreen was introduced for five visits where at the beginning of the visit, the doctor received a summary report of the screening results. All visits were audio recorded and analyzed using the Roter interaction analysis system. Doctor and teen dialogue and topics discussed were compared between the two groups.
  
  
  RESULTS
  Seven midcareer doctors and 72 adolescents participated; 37 visits without DartScreen and 35 with DartScreen were audio recorded. The Roter interaction analysis system defined medically related data gathering (mean, 36.8 vs. 32.7 statements; p = .03) and counseling (mean, 36.8 vs. 32.7 statements; p = .01) decreased with DartScreen; however, doctor responsiveness and engagement improved with DartScreen (mean, 4.8 vs. 5.1 statements; p = .00). Teens completing the DartScreen offered more psychosocial information (mean, 18.5 vs. 10.6 statements; p = .01), and mental health was discussed more after the DartScreen (mean, 93.7 vs. 43.5 statements; p = .03). Discussion of somatic and substance abuse topics did not change. Doctors reported that screening improved visit organization and efficiency.
  
  
  CONCLUSIONS
  Use of the screener increased discussion of mental health but not at the expense of other adolescent health topics.
authors.affiliation: Bassett Research Institute, Bassett Medical Center, Cooperstown, New York. Electronic address: anne.gadomski@bassett.org.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Gadomski
authors.affiliation: Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Kate E
authors.initials: KE
authors.lastname: Fothergill
authors.affiliation: Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Susan
authors.initials: S
authors.lastname: Larson
authors.affiliation: Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Lawrence S
authors.initials: LS
authors.lastname: Wissow
authors.affiliation: Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Heather
authors.initials: H
authors.lastname: Winegrad
authors.affiliation: Department of Family & Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
authors.forename: Zsolt J
authors.initials: ZJ
authors.lastname: Nagykaldi
authors.affiliation: Department of Pediatrics, Dartmouth Medical School, Lebanon, New Hampshire.
authors.forename: Ardis L
authors.initials: AL
authors.lastname: Olson
authors.affiliation: Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Debra L
authors.initials: DL
authors.lastname: Roter
mesh_terms: D000293:Adolescent; D000367:Age Factors; D019033:Delivery of Health Care, Integrated; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008403:Mass Screening / Q000295:instrumentation*; D008603:Mental Health; D009819:Office Visits / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000379:methods; D058996:Quality Improvement; D012016:Reference Values; D012424:Rural Population; D012737:Sex Factors; D014505:Urban Population; D014741:Video Recording; D055815:Young Adult
keywords: Adolescent; Mental health screening; Patient–doctor interactions; Previsit computerized screening