Smartphones and tablets “may hold the key” to helping more nurses to broach sensitive health issues like obesity, smoking, and depression with patients, claim US researchers.
Mobile devices loaded with a custom app that prompts the following of evidence-based guidelines during routine exams makes nurses “significantly” more likely to identify and tackle conditions that may not be the focus of the consultation, according to a study by Columbia University’s school of nursing.
The researchers evaluated “diagnosis rates” for tobacco use, adult and paediatric depression, and obesity during 34,349 patient exams conducted by 363 nurses enrolled in nurse practitioner programmes.
The nurses were randomly assigned to use mobile apps with or without decision support for guideline-based care.
“What clinicians need is decision support tools that fit into their workflow and remind them of evidence-based practices”
For each of the issues studied, apps with decision support features resulted in significantly higher diagnosis rates than apps with only “bare-bones” tools for recording results from a patient exam, said the study authors.
Increased diagnosis rates with the decision support were seven times more for obese and overweight (33.9% versus 4.8%) and five times more for tobacco use (11.9% versus 2.3%).
In addition, the diagnosis rate with the support was 44 times more for adult depression (8.8% versus 0.2%) and four times more for paediatric depression (4.6% versus 1.1%).
The app prompted nurse practitioners to follow evidence-based clinical guidelines to “screen, diagnose, and manage” specific conditions and encouraged detailed conversations with patients about their health, said the study authors.
For tobacco screening, for example, the app prompted nurses to ask not just about cigarettes but also about other products such as chewing tobacco, they said.
To diagnose patients who are overweight or obese, the app calculated body-mass-index to quickly pinpoint those who might benefit from weight-loss counselling and other interventions.
With depression, the app prompted nurses to ask a series of questions to make it easier to identify patients with depressive symptoms.
“What clinicians need is decision support tools that fit into their workflow and remind them of evidence-based practices,” said lead author Suzanne Bakken, professor of nursing and professor of biomedical informatics.
“Our app focused specifically on the work that nurse practitioners do to identify health problems, counsel patients, and coordinate care plans, resulting in higher diagnosis rates and more opportunities for intervention,” she said.
The study was published in the November/December 2014 issue of the Journal for Nurse Practitioners.