Webb Marianne Julie, Wadley Greg, Sanci Lena Amanda
Department of General Practice, Melbourne Medical School, Faculty of Medicine, University of Melbourne, Parkville, Australia.
School of Computing and Information Systems, University of Melbourne, Parkville, Australia.
JMIR Mhealth Uhealth. 2017 Aug 11;5(8):e118. doi: 10.2196/mhealth.7816.
Despite experiencing a high prevalence and co-occurrence of mental health disorders and health-compromising behaviors, young people tend not to seek professional help for these concerns. However, they do regularly attend primary care, making primary care providers ideally situated to identify and discuss mental health and lifestyle issues as part of young people's routine health care.
The aim was to investigate whether using a codesigned health and lifestyle-screening app, Check Up GP, in general practice influenced young people's assessment of the quality of their care (measures of patient-centered care and youth friendliness), and their disclosure of sensitive issues. In addition, this study aimed to explore young people's acceptance and experience of using a screening app during regular health care.
This was a mixed methods implementation study of Check Up GP with young people aged 14 to 25 years attending a general practice clinic in urban Melbourne, Australia. A 1-month treatment-as-usual group was compared to a 2-month intervention group in which young people and their general practitioners (GPs) used Check Up GP. Young people in both groups completed an exit survey immediately after their consultation about disclosure, patient-centered and youth-friendly care, and judgment. In addition, participants in the intervention group were surveyed about app acceptability and usability and their willingness to use it again. Semistructured interviews with participants in the intervention group expanded on themes covered in the survey.
The exit survey was completed by 30 young people in the treatment-as-usual group and 85 young people in the intervention group. Young people using Check Up GP reported greater disclosure of health issues (P<.001), and rated their GP higher in patient-centered care: communication and partnership (P=.01), personal relationship (P=.01), health promotion (P=.03), and interest in effect on life (P<.001). No differences were found on core indicators of youth-friendly care: trust, level of comfort, expectations met, and time to ask questions. In all, 86% (73/85) of young people felt the app was a "good idea" and only 1% (1/85) thought it a "bad idea." Thematic analysis of qualitative interviews with 14 participants found that Check Up GP created scope to address unmet health needs and increased sense of preparedness, with use moderated by honesty, motivation, app content and functionality, and app administration.
Integrating a health and lifestyle-screening app into face-to-face care can enrich young people's experience of seeing their GP, create scope to identify and address unmet health needs, and increase patient-centered care. Further research is needed to investigate the effect of using a health and lifestyle-screening app in a diverse range of clinic types and settings, and with a diverse range of GPs and youth.
尽管心理健康障碍与危害健康行为的高患病率及共现情况在年轻人中普遍存在，但他们往往不会就这些问题寻求专业帮助。然而，他们会定期去看初级保健医生，这使得初级保健提供者处于理想位置，能够在年轻人的常规医疗保健过程中识别并讨论心理健康和生活方式问题。
旨在调查在全科医疗中使用共同设计的健康与生活方式筛查应用程序“Check Up GP”是否会影响年轻人对其医疗质量的评估（以患者为中心的医疗和对年轻人友好程度的衡量指标）以及他们对敏感问题的披露。此外，本研究旨在探索年轻人在常规医疗保健期间对使用筛查应用程序的接受程度和体验。
这是一项针对“Check Up GP”的混合方法实施研究，研究对象为年龄在14至25岁、前往澳大利亚墨尔本市区一家全科诊所就诊的年轻人。将一个为期1个月的常规治疗组与一个为期2个月的干预组进行比较，干预组中的年轻人及其全科医生（GP）使用“Check Up GP”。两组年轻人在咨询结束后立即完成一份关于信息披露、以患者为中心和对年轻人友好的医疗以及判断的退出调查。此外，对干预组的参与者进行了关于应用程序可接受性、可用性以及他们再次使用意愿的调查。对干预组参与者进行的半结构化访谈进一步阐述了调查中涉及的主题。
常规治疗组的30名年轻人和干预组的85名年轻人完成了退出调查。使用“Check Up GP”的年轻人报告称，他们对健康问题的披露更多（P<.001），并且在以患者为中心的医疗方面对其全科医生的评分更高：沟通与伙伴关系（P=.01）、人际关系（P=.01）、健康促进（P=.03）以及对生活影响的关注度（P<.001）。在对年轻人友好的医疗的核心指标方面未发现差异：信任、舒适度、期望达成情况以及提问时间。总体而言，86%（73/85）的年轻人认为该应用程序是个“好主意”，只有1%（1/85）的人认为它是个“坏主意”。对14名参与者进行的定性访谈的主题分析发现，“Check Up GP”为解决未满足的健康需求创造了空间，并增强了准备意识，其使用受到诚实、动机、应用程序内容与功能以及应用程序管理的调节。
将健康与生活方式筛查应用程序整合到面对面医疗中，可以丰富年轻人看全科医生的体验，为识别和解决未满足的健康需求创造空间，并增加以患者为中心的医疗。需要进一步研究以调查在各种不同类型和环境的诊所中，以及与各种不同的全科医生和年轻人一起使用健康与生活方式筛查应用程序的效果。
