The Rapid Assessment for Adolescent Preventive Services (RAAPS): providers' assessment of its usefulness in their clinical practice settings

Improving Patient-Centered Dementia Screening for General, Multicultural Population and Persons with Disabilities from Primary Care Professionals with a Web-Based App

BACKGROUND

Primary care serves as the first point of contact for people with dementia and is therefore a promising setting for screening, assessment, and initiation of specific treatment and care. According to literature, online applications can be effective by addressing different needs, such as screening, health counseling, and improving overall health status.

AIM

Our goal was to propose a brief, inexpensive, noninvasive strategy for screening dementia to general, multicultural population and persons with disabilities, through a web-based app with a tailored multicomponent design.

METHODS

We designed and developed a web-based application, which combines cognitive tests and biomarkers to assist primary care professionals screen dementia. We then conducted an implementation study to measure the usability of the app. Two groups of experts participated for the selection of the screening instruments, following the Delhi method. Then, 16 primary care professionals assessed the app to their patients (n = 132), and after they measured its usability with System Usability Scale.

OUTCOMES

Two cognitive tools were integrated in the app, GPCOG and RUDAS, which are adequate for primary care settings and for screening multicultural and special needs population, without educational or language bias. Also, for assessing biomarkers, the CAIDE model was preferred, which resulted in individualized proposals, concerning the modifiable risk factors. Usability scored high for the majority of users.

CONCLUSION

Utilization of the Dementia app could be incorporated into the routine practices of existing healthcare services and screening of multiple population for dementia.

Utility of a psychosocial assessment during an acute care hospitalization

Adolescence involves immense physical, cognitive, social and emotional changes, which can lead teenagers to partake in risky behaviors. While experimentation and risk-taking are critical components of an adolescent's development of autonomy, these behaviors are known to contribute to the morbidity, mortality and social concerns of this age group. This observation prompted national organizations like the American Academy of Pediatrics to recommend risk behavior screening on an annual basis. Based on this recommendation and the time constraints of outpatient clinicians, as well as teenagers' underattendance for routine outpatient visits, hospital-based clinicians should implement the no-missed-opportunities paradigm⁵ when caring for adolescent patients. An acute care hospitalization for a teenager should serve as an additional opportunity to provide preventive care services. Utilization of a psychosocial screening tool can augment a clinician's ability to risk-stratify an adolescent, thus alerting the clinician to provide additional resources, education or interventions during that hospital encounter. The acronyms HEADDSS (Home, Education, Activities, Diet, Drugs, Sexual activity/sexuality and Safety/suicide) and SSHADESS (Strengths, School, Home, Activities, Drugs, Emotions/eating, Sexuality, Safety) can be employed as tools to remember the various elements of an adolescent's psychosocial health. In order to solicit honest, in-depth responses during the assessment, hospital-based pediatricians should strive to establish an environment of mutual trust. Clinicians should ask open-ended questions, remain non-judgmental and should preface any conversation involving sensitive topics with a discussion regarding the patient's right to confidentiality (and the circumstances in which it may be breeched). If risky behaviors are identified during the assessment, then appropriate counseling or intervention should be arranged during the acute care stay, with an outpatient follow-up plan established prior to discharge. By including the provision of preventative services in the inpatient setting, pediatric healthcare providers stand to add an additional layer of support for the adolescent population.

Previsit Multidomain Psychosocial Screening Tools for Adolescents and Young Adults: A Systematic Review

Adolescence and young adulthood constitute a period when exploratory behaviors can evolve into risky behaviors. Most causes of adolescent ill health are preventable; therefore, it is a priority to detect them early before they turn into health problems. Previsit multidomain psychosocial screening tools are used by professionals to detect and prioritize potentially problematic issues. In conjunction with appropriate clinician training, these tools have improved clinician screening rates in several areas of adolescent health. This article reviews existing multidomain previsit psychosocial screening tools developed in the 21st century and describes their characteristics using a systematic methodology. We reviewed 10,623 records to identify 15 different tools in use since 2000 and described their characteristics. Results show that all tools were developed in high-income countries. The tools provide sufficient coverage of many psychosocial domains relevant to young people's health. However, some psychosocial domains such as screen use and strengths are seldomly addressed. Furthermore, the tools rarely focus on young adults as a target population. Future research should assess the effectiveness, acceptability, and psychometric properties of validated psychosocial screening tools and examine how to expand their use in low- and middle-income countries.

[Non-suicidal self-injuries in adolescents: Prevention and detection in primary care]

Non-suicidal self-injuries (NSSI) are self-harm behaviours without a suicidal objective, and have a prevalence of 17-18% in adolescents. It is characterised by self-inflicted injuries, mainly in the extremities and abdomen. The psychopathology is subject to the presence of emotional deregulation, in which it seeks the masking of emotional pain with physical pain. A literature review was conducted using research in databases, including key words in English and Spanish. It was found that the identification of NSSI risk factors in adolescents helps in its prevention and identification, and as such it was proposed to classify the NSSI risk factors, as well as the tools for their identification in primary care. It was concluded that the management of NSSI corresponds to the child and adolescent psychiatrist, but primary care physicians have a fundamental role in its detection and prevention.

Experiences of General Practitioners and Practice Support Staff Using a Health and Lifestyle Screening App in Primary Health Care: Implementation Case Study

Background

Technology-based screening of young people for mental health disorders and health compromising behaviors in general practice increases the disclosure of sensitive health issues and improves patient-centered care. However, few studies investigate how general practitioners (GPs) and practice support staff (receptionists and practice managers) integrate screening technology into their routine work, including the problems that arise and how the staff surmount them.

Objective

The aim of this study was to investigate the implementation of a health and lifestyle screening app, Check Up GP, for young people aged 14 to 25 years attending an Australian general practice.

Methods

We conducted an in-depth implementation case study of Check Up GP in one general practice clinic, with methodology informed by action research. Semistructured interviews and focus groups were conducted with GPs and support staff at the end of the implementation period. Data were thematically analyzed and mapped to normalization process theory constructs. We also analyzed the number of times we supported staff, the location where young people completed Check Up GP, and whether they felt they had sufficient privacy and received a text messaging (short message service, SMS) link at the time of taking their appointment.

Results

A total of 4 GPs and 10 support staff at the clinic participated in the study, with all except 3 receptionists participating in the final interviews and focus groups. During the 2-month implementation period, the technology and administration of Check Up GP was iterated through 4 major quality improvement cycles in response to the needs of the staff. This resulted in a reduction in the average time taken to complete Check Up GP from 14 min to 10 min, improved SMS text messaging for young people, and a more consistent description of the app by receptionists to young people. In the first weeks of implementation, researchers needed to regularly support staff with the app’s administration; however, this support decreased over time, even as usage rose slightly. The majority of young people (73/87, 84%) completed Check Up GP in the waiting room, with less than half (35/80, 44%) having received an SMS from the clinic with a link to the tool. Participating staff valued Check Up GP, particularly its facilitation of youth-friendly practice. However, there was at first a lack of organizational systems and capacity to implement the app and also initially a reliance on researchers to facilitate the process.

Conclusions

The implementation of a screening app in the dynamic and time-restricted general practice setting presents a range of technical and administrative challenges. Successful implementation of a screening app is possible but requires adequate time and intensive facilitation. More resources, external to staff, are needed to drive and support sustainable technology innovation and implementation in general practice settings.

Using social media to engage adolescents and young adults with their health

We focus on the potential of social media related to the health of adolescent and young adults, who are nearly ubiquitous social media users but difficult to engage with their health and relatively low healthcare utilizers. Opportunities to better engage adolescents and young adults through social media exist in healthcare delivery, health education and health policy. However, challenges remain for harnessing social media, including making a clear value proposition and developing evidence-based frameworks for measuring the impact of social media on health.