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

Abstract

BACKGROUND Digital medical interview assistant (DMIA, 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 (PC) is the broadest in terms of the amount of topics to be covered and, at the same time, the shortest in term of time spent with the patient. OBJECTIVE To explore how DMIA systems may be used specifically in the context of PC, 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 PC consultation in general and for diabetes and depression specifically, and on (2) the impact of DMIA/CAHT systems on the medical consultation. Through thematic analysis, we identified the characteristics of the PC consultation that a DMIA system would be able to improve. Based on the identified PC 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 PC tasks of case finding/screening, diagnosing and, if needed, timely referral to specialists or urgent care. Similarly, for follow-up consultations, it could aid with the control/monitoring of these conditions, help check for additional health issues and for updating the PC 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; would improve the use of face-to-face consultation time, 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 PC and healthcare in general. CONCLUSIONS Given the benefits explored here, we foresee that DMIA systems could have an important impact in the PC 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 EMRs and CDSS. CLINICALTRIAL

Completion rate and satisfaction with online Computer Assisted History Taking questionnaires in Orthopedics: A Multicenter Cohort Study (Preprint)

“…Computer Assisted History Taking (CAHT) systems, also known as digital medical interview assistant systems, are software programs that allow patients to present their medical history electronically before an outpatient consultation. For instance, this can be done remotely via a webbased portal or smartphone application prior to the scheduled consultation [5]. CAHT was first introduced in the early 1970s as an additional channel to collect highly relevant, comprehensive, and accurate patient information [6].…”