Use of inexpensive technology to enhance adolescent health screening and counseling.

OBJECTIVES To describe the health issues reported using a personal digital assistant (PDA) to conduct screening at adolescent well visits, and to determine the effect of a PDA screening tool on the content and quality of the clinical interaction. DESIGN The PDA screening tool was used to record adolescent health risk behaviors, and cross-sectional exit surveys were administered before and after PDA introduction. SETTING Five primary care practices in New England. PARTICIPANTS The PDA screening was completed by 1052 youth aged 11 to 19 years. In addition, youth seen before (n = 65) and after (n = 98) PDA screening implementation completed exit surveys. Intervention Adolescents completed the PDA screening immediately before the well visit. Branching questions explored risk behaviors in more depth, including motivation to change. Physicians viewed the summarized findings before the adolescent health visit. MAIN OUTCOME MEASURES Health risk behaviors based on PDA data. Exit surveys assessed the quality of the visit and of any discussion of nutrition, exercise, screen time, tobacco use, alcohol and other drug use, and mood. RESULTS Multiple risk behaviors (n = 3-9) were reported by 30% of 11- to 14-year-olds and 45% of 15- to 19-year-olds. Exit surveys showed that, with PDA use, the proportion of visits that included discussions of health risk behaviors increased for fruit/vegetable intake (60.4% vs 41.7% without PDA use; P =.03), tobacco use (54.9% vs 40.0%; P = .07), and alcohol use (53.9% vs 38.0%; P =.05). With PDA use, more adolescents rated the visit as confidential (83.7% vs 61.5%; P =.002), more thought they were listened to carefully (87.8% vs 64.6%; P <.001), and more were very satisfied (87.8% vs 63.1%; P < .001). CONCLUSION Use of a PDA-based screening tool enhances physician counseling and improves adolescents' perceptions of the well visit.