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Population-Level Portal-Based Anxiety and Depression Screening Perspectives in HIV Care Clinicians: Qualitative Study
Daniela Zimmer1, Erin M Staab1, Jessica P Ridgway1
1Section of General Internal Medicine, University of Chicago, Chicago, IL, United States.
JMIR Formative Research
|January 11, 2024
Summary
Implementing depression and anxiety screening for people with HIV via patient portals shows promise. Key facilitators include patient privacy and tailored assessments, while barriers involve patient portal access and mental health service availability.
Area of Science:
- Implementation Science
- Public Health
- HIV Medicine
Background:
- Depression and anxiety are prevalent in people with HIV (PLWH), impacting health outcomes.
- Underdiagnosis and undertreatment stem from limited clinic resources and time.
- Patient portal screening offers a scalable solution for mental health assessment in HIV care.
Purpose of the Study:
- To identify facilitators and barriers to implementing population-level, portal-based depression and anxiety screening for PLWH.
- To inform strategies for successful integration of mental health screening into HIV care.
Main Methods:
- Qualitative study using semistructured interviews with HIV clinicians.
- Interviews guided by the Consolidated Framework for Implementation Research (CFIR).
- Analysis of 10 clinician interviews to identify implementation factors.
Main Results:
- Ten facilitators identified, including systematic screening benefits, tailored frequency, evidence support, patient privacy, and staff buy-in.
- Seven barriers identified, such as managing suicidal ideation, patient portal usability, limited mental health services, and provider capacity.
- Facilitators and barriers spanned multiple CFIR domains, highlighting system-level influences.
Conclusions:
- Proposed 13 strategies for successful portal-based screening implementation.
- Emphasized pre-implementation assessments, staff engagement, and highlighting screening benefits.
- Recommended adaptable screening frequency, user-centered design, on-demand tools, and clear protocols for positive screens.
- Advocated for ongoing communication, training, patient support, diverse screening methods, patient-centered messaging, clinical decision support, and integrated behavioral health.
