PDA screening can improve adolescent health counseling

Time is one of the most important barriers to more effective health counseling by pediatricians. But a recent study using personal digital assistants (PDAs) shows that technology can help make those few counseling minutes more useful and more effective.

"The adolescent visit is often a missed opportunity," said Ardis Olson, MD, Dartmouth Hitchcock Medical Center, Lebanon, NH. The typical teen has six to seven questions to discuss with a pediatrician, she said. But only one third of teens have the time to cover all the topics and just 12% of teens report covering all of their questions. Using a PDA makes for a more effective medical visit.

"We have found that using a PDA lets pediatricians spend less time gathering information from their patients so they have more time to talk with them and counsel them," Dr. Olson said.

Researchers programmed PDAs with a series of 66 health risk screening questions and up to 25 branching followup questions. A total of 1,052 teenage patients were given a PDA when they registered for a visit or when they were taken to the examination room.

Teens typically took seven to ten minutes to complete the survey, Dr. Olson reported, and did not need any instruction on how to use the PDA. Responses gave practitioners a summary of each patient's health risks and readiness to change behavior before the visit began.

"Our kids thought their doctor was pretty cool for using a PDA," Dr. Olson said. "And it let our clinicians shift their attention to discussion from information gathering."

The screening questions were based on GAP and separated into two age groups, 11 to 14 and 15 to 19. Questions covered diet, exercise, seat belt/helmet use, tobacco use, problem alcohol use, recreational and OTC drugs, unprotected sex, and other risky behaviors.

Among the 11 to 14 year-old group, 22% of patients had no risk factors. In the older 15 to 19 year-old group, 16% of patients had no risk factors. At the other end of the spectrum, 3% of 11 to 14 year-olds had six to ten risk factors compared to 10% of 15 to 19 year-olds.

"Screening results show that there is substantial work to be done in terms of healthier diet and exercise for adolescents," Dr. Olson said. "There is a window to help kids that we will miss if we don't ask. PDA surveys help show us where to focus our attention."