UCSF studies video risk assessment for primary care physicians

How would you like to see a doctor who takes the time to evaluate your smoking, alcohol and HIV/STD risks, and in about 15 minutes receive nonjudgmental support and advice about how to reduce risks and improve your health?

Recently, the UCSF Center for Health Improvement and Prevention Studies (CHIPS) received funding ($117,000) from the Robert Wood Johnson Foundation, to continue its work on multimedia, interactive computer technology as an adjunct to primary care.
A UCSF team plans to integrate a Video Doctor Risk Assessment and Brief Intervention Program into routine primary care to support patients in reducing their health behavior risks. If the Video Doctor program successfully assesses risk and supports patients in reducing risk behaviors, it could be seamlessly integrated into health settings, according to the experts.

Principal investigator of the CHIPS studies is Barbara Gerbert, PhD, UCSF professor and chair of the division of behavioral sciences in the UCSF School of Dentistry.  Gerbert has developed and is implementing a Video Doctor program to assess and intervene with smoking, alcohol and HIV risks.  The new program would support busy physicians in providing health behavior counseling to large groups of patients and would provide information for the health care provider about intervention strategies for patient risks. The current RWJ-funded study to integrate the Video Doctor with a primary care site will provide researchers with answers about how physicians and patients could routinely benefit from the use of this state-of-the-art technology.
“We want to simplify visits to a doctor, to make it easier for patients and clinicians to benefit from this kind of risk assessment,” Gerbert said.  “Also, physicians can get harried and busy, but the Video Doctor doesn’t.”

The Video Doctor Risk Assessment program is easy to use and accessible to patients with low literacy, no previous computer experience and to Spanish speakers.  The program simulates a live risk assessment interview with a physician.

To answer the Video Doctor’s questions, a patient clicks on the correct key on a simplified keyboard.  And if the patient is confused, the Video Doctor will restate the question.  “The program allows patients anonymity and privacy so the answers are easier to give,” Gerbert said. 

After assessing patient risks, the Video Doctor will provide individualized advice messages to support and motivate patients to reduce their risks.

The program was tested at three primary care sites, including UCSF Mount Zion, the UCSF Ambulatory Care Center, both part of the UCSF Medical Center, and Highland Hospital in Oakland, Calif. 

Patients said they liked using the Video Doctor and found it easy.
The Video Doctor has worked well in the past.  Previous funding from the National Institute of Mental Health (NIMH) gave health psychology researchers funding, developing an interactive Video Doctor which asked patients about their risks for HIV and sexually transmitted diseases.

More recently, the researchers have been investigating the use of a Video Doctor to study people’s preference about the race and gender of their physicians.  Last year, with funding from the National Institute of Alcohol Abuse and Alcoholism, the researchers went to a shopping mall in the San Francisco Bay Area and asked nearly 400 shoppers from diverse racial backgrounds to select one of six Video Doctors. 

The choices were both male and female who were either African American, Latin or Caucasian.
Although the majority of the people chose a female physician (85 percent of females and 65 percent of males), the results documented that from the public’s point of view, physicians of both genders and all races can possess desired qualities in a physician. 

The results also demonstrated that people may be receptive to any physician who has qualities such as being a good listener and non-judgemental, regardless of gender and race.  Participants in the study knew that the Video Doctor was an actor, and yet they reported that they responded to her or him as a “real” physician.

While the program received high ratings from all participants, it received the highest from African Americans, Hispanics, those with less education and older people, groups that previously were thought to be more difficult to reach with computer interventions.

Colleagues for the Video Doctor studies include Stephen McPhee, MD, UCSF professor of medicine and co-principal investigator; Judith Wofsy, MD, division chief of primary care at Highland Hospital department of medicine; Dale Danley, MPH, UCSF project coordinator of the RWJ project and Steven Berg-Smith, MA, project coordinator for the Video Doctor project at UCSF waiting rooms and Highland Hospital.