Improving the Primary Care Consultation for Diabetes and Depression Through Digital Medical Interview Assistant Systems: Narrative Review

Abstract

Background Digital medical interview assistant (DMIA) systems, also known as computer-assisted history taking (CAHT) systems, have the potential to improve the quality of care and the medical consultation by exploring more patient-related aspects without time constraints and, therefore, acquiring more and better-quality information prior to the face-to-face consultation. The consultation in primary care is the broadest in terms of the amount of topics to be covered and, at the same time, the shortest in terms of time spent with the patient. Objective Our aim is to explore how DMIA systems may be used specifically in the context of primary care, to improve the consultations for diabetes and depression, as exemplars of chronic conditions. Methods A narrative review was conducted focusing on (1) the characteristics of the primary care consultation in general, and for diabetes and depression specifically, and (2) the impact of DMIA and CAHT systems on the medical consultation. Through thematic analysis, we identified the characteristics of the primary care consultation that a DMIA system would be able to improve. Based on the identified primary care consultation tasks and the potential benefits of DMIA systems, we developed a sample questionnaire for diabetes and depression to illustrate how such a system may work. Results A DMIA system, prior to the first consultation, could aid in the essential primary care tasks of case finding and screening, diagnosing, and, if needed, timely referral to specialists or urgent care. Similarly, for follow-up consultations, this system could aid with the control and monitoring of these conditions, help check for additional health issues, and update the primary care provider about visits to other providers or further testing. Successfully implementing a DMIA system for these tasks would improve the quality of the data obtained, which means earlier diagnosis and treatment. Such a system would improve the use of face-to-face consultation time, thereby streamlining the interaction and allowing the focus to be the patient's needs, which ultimately would lead to better health outcomes and patient satisfaction. However, for such a system to be successfully incorporated, there are important considerations to be taken into account, such as the language to be used and the challenges for implementing eHealth innovations in primary care and health care in general. Conclusions Given the benefits explored here, we foresee that DMIA systems could have an important impact in the primary care consultation for diabetes and depression and, potentially, for other chronic conditions. Earlier case finding and a more accurate diagnosis, due to more and better-quality data, paired with improved monitoring of disease progress should improve the quality of care and keep the management of chronic conditions at the primary care level. A somewhat simple, easily scalable technology could go a long way to improve the health of the millions of people affected with chronic conditions, especially if working in conjunction with already-established health technologies such as electronic medical records and clinical decision support systems.

A Human, Organization, and Technology Perspective on Patients’ Experiences of a Chat-Based and Automated Medical History–Taking Service in Primary Health Care: Interview Study Among Primary Care Patients

“…Automated medical history taking can improve the quality of care and increase patient satisfaction; patients can document their medical history without any interference or time constraints, and HCPs can prepare for consultations in a time-efficient manner [ 8 , 9 ]. Earlier studies from primary care have suggested many benefits of using automated medical history taking, such as enabling triage prioritization and increasing diagnostic precision [ 10 ]. Potential risks include erroneous information, loss of nonverbal cues, and low digital literacy.…”

The Effect of a Pre-consultation Tablet-Based Questionnaire on Changes in Consultation Time for First-Visit Patients With Diabetes: A Single-Case Design Preliminary Study

“…It has been reported that a preliminary interview can reveal the patient's own issues [ 12 ] and that pre-interviews (including via the web) may deepen communication at the initial visit and enhance clinical decision-making. The use of a pre-clinical question prompt list (QPL) in breast cancer genetic counseling has been reported to be useful for assertive communication [ 13 ], and it has been noted that digital interview assistants may have a significant impact on diabetes care, including improved quality of care [ 14 ]. For these reasons, it was thought that prior information improved communication as well as face-to-face clinic time.…”

Asociación entre diabetes y depresión en una población hospitalaria con diabetes mellitus.

“…(15) A nivel somático se conoce que la depresión y el estrés crónico activan el eje hipotálamo -hipofisario-suprarrenal, estimulando al sistema nervioso simpático, aumentando la agregación plaquetaria y los fenómenos inflamatorios, generando insulinorresistencia, favoreciendo un mal control metabólico. (16,17) Se ha informado que el diagnóstico y tratamiento de la depresión en forma oportuna, mejora el control glucémico y previene o retrasa las complicaciones; (18)(19)(20) a pesar de ello, en los países de bajos y medianos ingresos hay escasez de datos sobre la carga de depresión entre los pacientes con diabetes. (21) Considerando la jerarquía del tema y la gran variabilidad reportadas en estudios publicados a nivel internacional, se realiza este trabajo cuyos objetivos son: conocer la frecuencia de síntomas depresivos y su relación con factores sociodemográficos, control metabólico, tratamiento farmacológico y complicaciones crónicas en una población con DM1 y DM2 que se asiste en una policlínica especializada en hospital de tercer nivel.…”