California Researchers Develop Interactive Program for Waiting-Room Patients About Smoking and Alcohol Use
Researchers at the University of California, San Francisco, School of Dentistry worked to revise their prototype patient education program "Video Doctor" so that patients can operate it independently in their physicians' offices. They created it under a grant from the National Institute on Alcohol Abuse and Alcoholism.
Video Doctor is an interactive computer program that patients can use in physicians' waiting rooms to receive targeted risk-reduction information and suggestions regarding their smoking and alcohol use.
The project staff:
- Modified Video Doctor so that patients could operate it independently in the primary care clinic setting.
- Developed six prototypes of "cueing reports." These reports provide physicians with a summary of the patient's risky behaviors and readiness to change. The reports also include easy-to-follow scripts to help physicians relay advice about behavioral risks.
The Robert Wood Johnson Foundation (RWJF) provided a grant of $116,916 from January 2002 to January 2003 to support the project.
Brief interventions from health care providers are an important way to inspire and support patients' efforts to change unhealthy lifestyle habits. However, many health care professionals neglect to screen patients about their behavioral risks.
To address this problem, in 1998 the National Institute on Alcohol Abuse and Alcoholism funded "Project Choice" at the University of California, San Francisco, School of Dentistry. The project was an effort to develop an interactive, multimedia program that would assess for, and intervene with, patients' smoking and alcohol use.
The result was Video Doctor, an interactive program that simulates a live patient-provider encounter through digital video clips. The patient initiates the program and responds to questions from the Video Doctor, an actor portraying a physician. The Video Doctor then delivers an appropriate assessment based on patient responses and offers targeted risk-reduction information and suggestions.
An assessment study of 800 patients using Video Doctor showed that both patients and providers responded favorably.
RWJF funded researchers at the University of California, San Francisco, School of Dentistry to adapt Video Doctor so that it could be used in primary care settings. To accomplish this, the project staff needed to modify the program to allow patients to use it without intruding on normal clinic operations or requiring staff time, and without delaying their appointments with providers.
The project staff also planned to give Video Doctor the capacity to produce "cueing reports" that would be included in the patient's chart. Cueing reports are sheets that contain a summary of the patient's risk behaviors, readiness to change, and an easy-to-follow script that helps providers relay advice to patients concerning their behavioral risks.
To assist in developing the adaptation and reviewing the program modifications, the project staff established a five-member advisory board of local doctors, nurse practitioners and administrative staff members. The research took place at the Highland Hospital Primary Care Clinic (Oakland, Calif.) where many of the patients are poor, have a high risk for tobacco use and alcohol abuse, and rarely receive targeted preventive services.
The project staff held four focus groups: one with physicians, one with clinic staff members and two with patients. The physician focus group of eight attendees addressed what information was most important for the Video Doctor program to gather from patients.
The clinic group of nine attendees reviewed the program and endorsed it for both its nonjudgmental tone and its potential to make good use of patients' time in the waiting room. The 15 attendees making up the two patient groups rated its communication style as better than their real physicians' because of its less judgmental attitude and offering of relevant information. The patients easily accepted the idea that the program might share their answers with their physician and they believed that it could potentially save patients time and improve their medical care.
- Project staff modified Video Doctor so that patients could operate it independently in the primary care clinic setting. To compensate for a lack of computer literacy among the primary care clinic population, the staff made Video Doctor especially user-friendly. They added an introductory graphic screen with pictures to demonstrate how to initiate program participation, and they developed a graphic poster to reinforce the steps. To start the program, the staff added a star symbol to the keyboard that was already simplified, with just yes, no, delete, repeat and number keys. The staff also simplified the risk-assessment component and added messages that encourage patients to bring up their behavioral risks with their doctor.
- Project staff was able to develop six prototypes of cueing reports for possible patient profiles. However, they were unable to develop the broader range of more personalized reports they had hoped for. Project staff had planned to produce cueing reports with 10 to 20 data points per sheet and highly variable text pegged to particular patient factors such as age, gender and stage of change. This proved to be too complex and costly for the project.
In June 2002, project staff were invited to demonstrate Video Doctor at a conference, "Technology, Health, and Philanthropy," a joint board meeting of the Rockefeller Foundation and the California Endowment, in response to an invitation to do so. The project had limited local Web site and radio coverage.
- A lack of treatment programs to offer patients who report substance abuse would limit to some degree the suitability of a Video Doctor program. For example, in the project location, physicians have no detoxification programs for referral of patients reporting problem drinking. (Project Director)
- In working with a software technician adapting a computer program, you must be sure you agree on the envisioned goal. It is critical to locate a technician who understands exactly what you want and who has the capability to do the job. (Project Director)
AFTER THE GRANT
In fall 2002, the National Institute on Drug Abuse (NIDA) awarded a $1.4-million four-year grant to the grantee organization to develop an expanded Video Doctor program focusing on risk behavior assessment and intervention for clinic patients with HIV. In September 2003, NIDA provided an additional $1.5-million grant to support investigation of how a multimedia Video Doctor could be used in prenatal care settings. Because of lack of funds, the project staff did not move forward after completing this project by implementing Video Doctor in the primary care clinic at Highland Hospital.
GRANT DETAILS & CONTACT INFORMATION
Integrating a Behavioral Risk Assessment and Brief Intervention Tool into Primary Care Settings
University of California, San Francisco, School of Dentistry (San Francisco, CA)
Dates: January 2002 to January 2003
Barbara Gerbert, Ph.D.
Report prepared by: Janet Spencer King
Reviewed by: Robert Crum
Reviewed by: Marian Bass
Program Officer: C. Tracy Orleans