South Texas Psychiatric PBRN Successes and Challenges of Conducting Health Research

Who is the South Texas Psychiatric PBRN The South Texas Psychiatric PBRN is an organization of community clinicians who collaborate together with UTHSCSA researchers to answer meaningful questions that will improve practice and patient care. Network is composed of 72 individual Psychiatrist in and around South Texas. PBRNs have been recognized as excellent tools for conducting a variety of research activities in primary care.

Successes Current research project (in the final steps of data collection): SSRIs and Alcohol Risk Completed research projects: Examining Negative Reactions: A Feasibility Study Examination of the Doctor-Patient Relationship

Successes - Cont. Publications The South Texas Psychiatric Practice – Based Research Network Published in San Antonio Medicine.com - www.samemedicine.com How not to be a difficult patient Published in Thought Broadcast – www.thoughtbroadcast.com A Psychiatrist’s Thoughts – Straight To Your Head & HCPlive.com

Challenges Clinician participation Choosing a project from many ideas Plan translating into streamlined procedure

How the latest project came to life… The purpose of this pilot project is to address a real world problem encountered by many psychiatrists, patients withholding topics of concern till the last minute of a psychiatric appointment. This issue was identified by fellow psychiatrists at one of our quarterly Psychiatry PBRN meetings. Through discourse it was decided that, with the assistance of an implemented tablet- based agenda setting tool, we would develop a method for patients to outline the agenda of each visit prior to the start of their session.

Project Overview This study is being conducted by the Psychiatric PBRN in collaboration with EvaluTrac LLC to develop and test Session Conversation Starter tablet-based agenda setting tool (SCS TBAST) in the clinical setting. The SCS TBAST will allow the patient to flag important issues or concerns prior to the start of their session. This project aims to integrate technology into the clinical setting by administering an agenda setting tool to assist the psychiatrist and patient in the course of their treatment plan.

Real World Significance AGENDA SETTING: The Affordable Care Act has encouraged providers to involve patients as proactive participants in maintaining their own good health, by effectively managing their chronic disease and engaging in shared decision making with their physicians. Patient activation requires the patient to be involved in the decision making process of their own treatment and insists that the patient has the knowledge, skills, and confidence needed to manage one's own health.

IIMS CE GRANT AWARD Title: Pilot Study to Develop & Evaluate the South Texas Psychiatric PBRN’s Session Conversation Starter Tablet-Based Agenda Setting Tool (SCS TBAST) to Enhance Psychiatric Follow-up visits. TECHNOLOGY USED IN CLINICAL PRACTICE: The use of electronic devices to assist in clinical management of medically ill patients has gained widespread interest and use (Heron & Smyth, 2010; Forchuk, Donelle, Ethridge & Warner, 2015). Electronic devices such as smartphones/tablets and wearable programmable devices have been developed to monitor a variety of patient physiological and psychological variables of clinical usefulness, but typically their use has been restricted to primary care settings

Methods The project will distribute 5 tablets in two month waves to 5 PBRN member practices (N=10 Psychiatrists). Psychiatrists will be expected to use the device for 2 months with all consecutive follow-up patients that volunteer to participate in the project. Estimated Patient enrollment for each psychiatrist is 20+ patients.

Methods - Cont. Three surveys will be administered to evaluate the effectiveness and overall satisfaction of the patient-doctor interface: Pre-Patient Questionnaire - To be filled out before using the SCS TBAST Post-Patient Questionnaire - To be filled out after using the SCS TBAST Psychiatrist Questionnaire - To be filled at the end of the follow-up visit

Expected Findings We anticipate that this project will Promote a simplified collaborative decision-making between psychiatrist and their patients by using the tablet to help set the agenda for clinician visits Create a more efficient follow-up visit resulting in a decline of patient-withheld concerns Improve satisfaction for both patient and psychiatrist Improve patient outcomes overall

Conclusion - Next Steps We are currently in the process of recruiting more psychiatrists for the project. May 2016 is our expected start date. We expect to use the SCS TBAST with over two hundred patients within the following year. The South Texas Psychiatric PBRN members participating in this project will provide exit interviews with their views and suggestions for improving technology like this in the clinical setting for future purposes. We hope to be able to distribute this product to other psychiatrists who may need assistance in developing physician-patient collaborative decision-making.