Feasibility of automated pre-screening for lifestyle and behavioral health risk factors in primary care.
BACKGROUND
Screening of primary care patients for unhealthy behaviors and mental health issues is recommended by numerous governing bodies internationally, yet evidence suggests that provider-initiated screening is not routine practice. The objective of this study was to implement systematic pre-screening of primary care patients for common preventive health issues on a large scale.


METHODS
Patients registered for non-acute visits to one of 40 primary care providers from eight clinics in an Academic Medical Center health care network in the United States from May, 2012 to May, 2014 were contacted one- to three-days prior to their visit. Patients were invited to complete a questionnaire using an Interactive Voice Response (IVR) system. Six items assessed pain, smoking, alcohol use, physical activity, concern about weight, and mood.


RESULTS
The acceptance rate among eligible patients reached by phone was 65.6 %, of which 95.5 % completed the IVR-Screen (N = 8,490; mean age 57; 57 % female). Sample demographics were representative of the overall primary care population from which participants were drawn on gender, race, and insurance status, but participants were slightly older and more likely to be married. Eighty-seven percent of patients screened positive on at least one item, and 59 % endorsed multiple problems. The majority of respondents (64.2 %) reported being never or only somewhat physically active. Weight concern was reported by 43.9 % of respondents, 36.4 % met criteria for unhealthy alcohol use, 23.4 % reported current pain, 19.6 % reported low mood, and 9.4 % reported smoking.


CONCLUSIONS
The percent endorsement for each behavioral health concern was generally consistent with studies of screening using other methods, and contrasts starkly with the reported low rates of screening and intervention for such concerns in typical PC practice. Results support the feasibility of IVR-based, large-scale pre-appointment behavioral health/ lifestyle risk factor screening of primary care patients. Pre-screening in this population facilitated participation in a controlled trial of brief treatment for unhealthy drinking, and also could be valuable clinically because it allows for case identification and management during routine care.
Department of Psychiatry, the University of Vermont, Burlington, VT, USA. gail.rose@vtmednet.org.
Gail L
GL
Rose
Office of Research Administrative Services, Harvard University, Cambridge, MA, USA. tonya_ferraro@harvard.edu.
Tonya A
TA
Ferraro
Department of Medical Biostatistics, The University of Vermont, Burlington, VT, USA. jskelly@uvm.edu.
Joan M
JM
Skelly
Department of Medical Biostatistics, The University of Vermont, Burlington, VT, USA. gbadger@uvm.edu.
Gary J
GJ
Badger
Department of Medicine, The University of Vermont, Burlington, VT, USA. Charles.maclean@vtmednet.org.
Charles D
CD
MacLean
Department of Public Health and Preventive Medicine, University of Kansas, Kansas City, 10, USA. tfazzino@kumc.edu.
Tera L
TL
Fazzino
Department of Psychiatry, the University of Vermont, Burlington, VT, USA. john.helzer@vtmednet.org.
John E
JE
Helzer
D000293:Adolescent; D000328:Adult; D000368:Aged; D001331:Automation / Q000379:methods; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012309:Risk-Taking; D011795:Surveys and Questionnaires; D055815:Young Adult