The Feasibility of Computerized Patient Self-assessment at Mental Health Clinics

Objectives Improving the quality of care for severe mental illness (SMI) has been difficult because patients’ clinical information is not readily available. Audio computer-assisted self-interviewing (ACASI) supports data collection by asking patients waiting for appointments clinical questions visually and aurally. It has improved outcomes for many disorders. While reliable and accurate for SMI in research settings, this study assesses questions about ACASI’s feasibility in usual care. Design Patient and provider surveys and provider focus groups after 12 months of ACASI implementation. Setting Two outpatient mental health clinics in Los Angeles, one run by the Department of Veterans Affairs and the other by Los Angeles County Department of Mental Health. Participants 266 patients with SMI and 14 psychiatrists. Intervention Patients completed an ACASI survey on symptoms, drug use, medication adherence and side-effects by internet using a touch-screen monitor. A 1-page report summarizing each patient’s results was printed and given to providers by patients during appointments. Main Outcome Measure Feedback surveys (patients and psychiatrists) and focus groups and interviews (psychiatrists) assessed usability, usefulness, effects on treatment, and barriers to sustaining ACASI. Results Patients believed the PAS was enjoyable, easy to learn and use, and that it improved communication with their psychiatrists. Providers believed the PAS was easy to use, had a small impact on care, could be improved by being more detailed and comprehensive, and requires outside support to continue its use. Conclusions ACASI was easy to use and enhanced communication. Systems like this can be a valuable part of quality improvement projects.