The screening test, known as eCHAT (electronic case-finding and help assessment tool) was invented and developed by Professor Felicity Goodyear-Smith and her team at The University of Auckland’s School of Population Health.
“When we see people in general practice, we often don’t have time to ask the broader questions around risky behaviours or how they are feeling, but these can impact on their wellbeing. We can do all the other interventions right, but that might not help them if they have other underlying concerns that are not known,” says Professor Goodyear-Smith.
Medical centres can use eCHAT (available on a computer tablet such as an iPad), as an initial screening tool for risky behaviours and mood problems that can affect peoples’ health and wellbeing.
eChat has undergone a decade of research and development with the latest trials completed by patients and GPs last year. It is now being trialled with another 30 user groups, ranging from rural and urban health centres, GPs with high Maori or Pacific Island rolls, a retirement village, student health centres and two high schools.
The eCHAT test takes a person about two to five minutes while waiting for a GP consultation. It has a branching logic that follows up questions on personal issues such as their tobacco, alcohol, or drug use, and gambling behaviour. It also asks questions on problems such as depression, anxiety, abuse, anger management and physical inactivity.
“If some of these questions were asked in isolation by a GP, people may feel picked on, but there is a virtue when they are all there together, “ says Professor Goodyear-Smith. “Because the questions are grouped together, they are more acceptable than if they were singled out.”
eCHAT includes an innovative ‘help’ question that asks patients if they would like help with these issues either during the visit or later on. It also asks whether patients want to take action to improve their mood or health behaviours.
“This enables patients to prioritise their problems, prevents doctor overload, and facilitates the conversation between patient and doctor about aspects of their lives that they want to change,” she says. “It encourages a patient to engage in their own self-management, and this will be an important tool in future, as the doctor to patient ratio decreases.”
A summary of eCHAT results is immediately accessible to the GP or practice nurse via their Patient Management System and includes the scored and interpreted results of the additional screening tests. Responses to eCHAT can also be linked to decision supports and suggested interventions for the issue needing to be addressed.
Eventually, it is hoped eCHAT will be available to people in their homes via ‘patient portals’ online, and enable them to access self-management options without having to visit their GP.
“eCHAT could provide the initial steps for someone to follow-up themselves, such as green prescriptions, community agencies, or how to access secondary care,” says Professor Goodyear- Smith.
“In future our increasing and aging population will have fewer GPs available and this is a way of helping them self-manage to help reduce the burden on primary health care providers”, she says.
The University of Auckland