Better health while you wait: A controlled trial of a computer-based intervention for screening and health promotion in the emergency department

Study objective: We evaluate a computer-based intervention for screening an d health promotion in the emergency department and determine its effect on patient recall of health advice. Methods: This controlled clinical trial, with alternating assignment of pat ients to a computer intervention (prevention group) or usual care, was cond ucted in a university hospital ED. The study group consisted of 542 adult p atients with nonurgent conditions. The study intervention was a self-admini stered computer survey generating individualized health information. Outcom e measures were (1) patient willingness to take a computerized health risk assessment, (2) disclosure of behavioral risk factors, (3) requests for hea lth information, and (4) remembered health advice. Results: Eighty-nine percent (470/542) of eligible patients participated. N inety percent were black. Eighty-five percent (210/248) of patients in the prevention group disclosed 1 or more major behavioral risk factors includin g current smoking (79/248; 32%), untreated hypertension (28/248; 13%), prob lem drinking (46/248; 19%), use of street drugs (33/248;13%), major depress ion (87/248; 35%), unsafe sexual behavior (84/248; 33%), and several other injury-prone behaviors. Ninety-five percent of patients in the prevention g roup requested health information. On follow-up at 1 week, 62% (133/216) of the prevention group patients compared with 27% (48/180) of the control su bjects remembered receiving advice on what they could do to improve their h ealth (relative risk 2.3, 95% confidence interval 1.77 to 3.01). Conclusion: Using a self-administered computer-based health risk assessment , the majority of patients in our urban ED disclosed important health risks and requested information. They were more likely than a control group to r emember receiving advice on what they could do to improve their health. Com puter methodology may enable physicians to use patient waiting time for hea lth promotion and to target at-risk patients for specific interventions.