心理健康的计算机辅助客户评估调查：患者和医疗服务提供者的观点
Computer-assisted client assessment survey for mental health: patient and health provider perspectives.
作者信息
Ferrari Manuela, Ahmad Farah, Shakya Yogendra, Ledwos Cliff, McKenzie Kwame
机构信息
School of Health Policy and Management, York University, 4700 Keele Street, HNES Building, Rm 414, Toronto, ON, M3J1P3, Canada.
Access Alliance Multicultural Health and Community Services, 340 College Street, Suite 500, Toronto, ON, M5T3A9, Canada.
出版信息
BMC Health Serv Res. 2016 Sep 23;16(1):516. doi: 10.1186/s12913-016-1756-0.
BACKGROUND
The worldwide rise in common mental disorders (CMDs) is posing challenges in the provision of and access to care, particularly for immigrant, refugee and racialized groups from low-income backgrounds. eHealth tools, such as the Interactive Computer-Assisted Client Assessment Survey (iCCAS) may reduce some barriers to access. iCCAS is a tablet-based, touch-screen self-assessment completed by clients while waiting to see their family physician (FP) or nurse practitioner (NP). In an academic-community initiative, iCCAS was made available in English and Spanish at a Community Health Centre in Toronto through a mixed-method trial.
METHODS
This paper reports the perspectives of clients in the iCCAS group (n = 74) collected through an exit survey, and the perspectives of 9 providers (four FP and five NP) gathered through qualitative interviews. Client acceptance of the tool was assessed for cognitive and technical dimensions of their experience. They rated twelve items for perceived Benefits and Barriers and four questions for the technical quality.
RESULTS
Most clients reported that the iCCAS completion time was acceptable (94.5 %), the touch-screen was easy to use (97.3 %), and the instructions (93.2 %) and questions (94.6 %) were clear. Clients endorsed the tool's Benefits, but were unsure about Barriers to information privacy and provider interaction (mean 4.1, 2.6 and 2.8, respectively on a five-point scale). Qualitative analysis of the provider interviews identified five themes: challenges in Assessing Mental Health Services, such as case complexity, time, language and stigma; the Tool's Benefits, including non-intrusive prompting of clients to discuss mental health, and facilitation of providers' assessment and care plans; the Tool's Integration into everyday practice; Challenges for Use (e.g. time); and Promoting Integration Effectively, centered on the timing of screening, setting readiness, language diversity, and technological advances.
CONCLUSIONS
Participant clients and providers perceived iCCAS as an easy and useful tool for mental health assessments at the Community Health Centre and similar settings. The findings are anticipated to inform further work in this area.
TRIAL REGISTRATION
ClinicalTrials.gov; NCT02023957 ; Registered retrospectively 12 Dec. 2013.
背景
全球常见精神障碍（CMD）患病率上升，给医疗服务的提供和可及性带来挑战，尤其是对来自低收入背景的移民、难民和种族化群体而言。电子健康工具，如交互式计算机辅助客户评估调查（iCCAS），可能会减少一些获取医疗服务的障碍。iCCAS是一种基于平板电脑的触摸屏自我评估工具，由客户在等待看家庭医生（FP）或执业护士（NP）时完成。在一项学术社区倡议中，通过一项混合方法试验，在多伦多的一家社区健康中心以英语和西班牙语提供了iCCAS。
方法
本文报告了通过退出调查收集的iCCAS组客户（n = 74）的观点，以及通过定性访谈收集的9名医疗服务提供者（4名家庭医生和5名执业护士）的观点。从认知和技术维度评估了客户对该工具的接受度。他们对感知到的益处和障碍的12个项目以及技术质量的4个问题进行了评分。
结果
大多数客户报告称，iCCAS的完成时间可以接受（94.5%），触摸屏易于使用（97.3%），说明（93.2%）和问题（94.6%）清晰明了。客户认可该工具的益处，但对信息隐私和与医疗服务提供者互动方面的障碍不确定（在五点量表上，平均分分别为4.1、2.6和2.8）。对医疗服务提供者访谈的定性分析确定了五个主题：评估心理健康服务方面的挑战，如病例复杂性、时间、语言和污名化；该工具的益处，包括非侵入性地促使客户讨论心理健康，以及便于医疗服务提供者进行评估和制定护理计划；该工具融入日常实践；使用方面的挑战（如时间）；以及有效促进融合，重点在于筛查时机、准备就绪情况、语言多样性和技术进步。
结论
参与的客户和医疗服务提供者认为iCCAS是社区健康中心及类似场所进行心理健康评估的一种简便且有用的工具。研究结果预期将为该领域的进一步工作提供参考。
试验注册
ClinicalTrials.gov；NCT02023957；2013年12月12日追溯注册。
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