Computer-assisted health counselor visits - A low-cost model for comprehensive adolescent preventive services

Objective: To evaluate a low-cost strategy for providing preventive health services to adolescents using computerized health assessments with individu alized educational videos, trained health counselors, and nurses. Design: Feasibility study, cost analysis, and comparative evaluation of hea lth problems identified, guidance delivered, and patient satisfaction. Setting: Eleven sessions at nontraditional sites including schools, univers ities, shopping malls, and afterhours clinics on Oahu, Hawaii. Participants and Intervention: Adolescents (N=258, mean age 17 years) compl eted confidential computerized health assessments, received individualized feedback, and viewed automatically selected educational videos on a laptop computer. The computer additionally printed a prioritized problems list for the graduate student-level health counselor to review with the adolescent. The counselor subsequently reviewed each encounter with a nurse-educator w ho performed further counseling and physical examinations when indicated. Results: Visit length averaged 44 minutes. Subjects spent an average of 21 minutes completing the automated health assessment and viewing interactive multimedia and 15 minutes with the health counselor. One third of subjects required further evaluation and counseling by the nurse (average, 8 minutes ). A team of 2 counselors and 1 nurse provided comprehensive screening, hea lth counseling, and physical examinations to I patient every 10 minutes at a salary cost of $7.46 per visit. This model identified risk behaviors at l evels consistent with local behavioral data, and addressed and documented t hem significantly more often than do physicians in traditional settings. Su bjects (71%) preferred the computer-assisted visits to standard office visi ts, and 92% felt the amount of time spent was acceptable. Conclusions: Computer-assisted delivery of adolescent preventive services u sing nonphysician health-counselors is a feasible, economical, and acceptab le alternative to traditional clinical practice for screening young people for health-compromising behaviors and providing individualized health educa tion and routine physical examinations. This model would likely increase ad olescents' access to needed preventive services at a very modest cost.