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Electronic letters published:
![[Read Comment]](/icons/misc/sectionDOWN.gif){kind=icon}
"A useful instrument for primary care physicians"
A useful instrument for primary care physicians
Does indication they want help correlate with readiness to change?
A great tool that deserves wide implementation
Wanting help might correlate to intention
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Felicity A Goodyear-Smith, Auckland, New Zealand GP
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We agree with Prof Dowrick. If patients identify a risky behaviour (eg smoking) but indicate that they do not want help with this issue, the door is still open to explain what assistance could be made available, and to revisit at the next consultation. Patients may not have considered some of the CHAT issues, such as gambling, abuse or difficulty with anger control, are problems they can share with their GP, and by answering the CHAT the seed has been sown for them to raise these at a later date. Competing interests: None declared |
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Christopher F Dowrick, Liverpool, UK Professor of Primary Medical Care, University of Liverpool
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Goodyear-Smith and her colleagues present a simple and useful instrument for alerting primary care physicians to the presence of a range of psychosocial problems which are common amongst patients attending primary care. The inclusion of a help-seeking question not only increases specificity of case-finding, but also provides a neat clarification of whether - and when - the patient might wish for help with the identified problem. I will certainly introduce CHAT to my own clinical practice, and will encourage colleagues to do the same - with two caveats: 1. Do not assume that no problem necessarily means no problem. Patients may not feel ready to acknowledge that they have a problem with alcohol or gambling, or be able to report experiences of abuse. 2. Do follow-up on identified problems, even if you don't know what to do about them. Primary care physicians tend to be confident in managing problems related to smoking, depression and exercise. However we may find discussion of domestic violence or sexual abuse disconcerting, and threatening to our professional identity because we do not have any ready- made answers. The response here is not to avoid the problem, but to increase our knowledge and skills and - if need be - to campaign for increased resources (1). (1) Feder G. Responding to intimate partner violence: what role for general practice? Br J Gen Pract 2006; 56: 243–244. Competing interests: None declared |
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Felicity A Goodyear-Smith, Auckland, New Zealand Family physician and Associate Professor
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Catherine Hudson raises the important question of whether patients’ indication they want help is correlated to intention to change. We agree that case-finding is only of value if it leds to improved health outcomes. Our current project involves patients completing the CHAT on a waiting room touch screen and the results available in the physician's elctronic medical records during the consultation. Following this our next step is an RCT to test the question of whether use of the CHAT leads to a reduction in risky behaviours and an increase in mental health. Competing interests: None declared |
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Carlos Roberto Jaen, San Antonio, Texas USA Professor of Familly Medicine, University of Texas Health Science Center at San Antonio
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Goodyear-Smith and colleagues provides us with an elegant and simple approach to a problem that haunts us frequently in primary care: How do we identify behavioral issues that need intervention and how do we prioritize them? Their response is a tool that keeps the patient in the driver's seat, that does not overwhelm current consultations and allows for planning for the future for the particular patient. Most brief behavioral interventions tend to focus on a particular risky behavior but are done in the context of multiple risky behaviors occurring simultaneously in the same person. We have brief interventions that are known to be effective but often are not implemented because fear of "opening Pandora's Box." This tool supports the clinician and the patient in their ability to select what gets done today. Patients can potentially complete the surveys either by paper and pencil, and/or online. CHAT is a great tool that ought to be adopted as widely as possible. This is truly a great step forward in our ability to implement effective brief behavioral interventions in primary care offices. Thank you. Competing interests: None declared |
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Catherine Hudon, Saguenay, Canada Associate professor, University of Sherbrooke
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As stated by the authors, the Case-finding and Help Assessment Tool (CHAT) seems a very promising questionnaire for primary care clinicians to identify patients with problematic conditions and to allow them to prioritize the issues they wish to address. I agree also with the authors that this tool may promote self-reliance and self-determination since it invites respondents to consider whether and when they want help. Goodyear-Smith et al. state that patients’ indication that they want help is likely to correlate with their readiness to change. This hypothesis deserves further investigation. It would also be interesting to test if patients’ indication that they want help is correlated to intention (1). 1- Ajzen I. From intentions to actions: A theory of planned behavior. In: Kuhl J, Beckman J, eds. Action-control: from cognition to behaviour. Heidelberg: Springer; 1985:11-39. Competing interests: None declared |
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