Screening for lifestyle and mental health risk factors in the waiting room Feasibility study of the Case-finding Health Assessment Tool

Objective To assess the feasibility and acceptability of administering the validated Case-finding Health Assessment Tool (CHAT) in Canadian family practice waiting rooms to identify risk factors for depression, anxiety, anger control, smoking, drinking, other drug use, gambling, exposure to abuse, and physical inactivity. Design Cross-sectional survey. Setting One urban academic family practice and one inner-city community health centre in British Columbia. Participants Convenience sample of consecutive adult patients (19 years of age or older) and their attending family physicians. Main outcome measures Rates of completion; positive responses to and wanting help with identified lifestyle and mental health risk factors; rates of objections to any questions; and positive and negative comments about the CHAT by participating physicians and patients. Results A total of 265 eligible adults presented in the waiting rooms over 5 full days and 3 half-days, 176 (66%) of whom enrolled in the study; 161 (91%) completed the CHAT, and 107 (66%) completed acceptability feedback forms. The prevalence of risk factors among patients in the academic and inner-city practice samples was different, with 20% and 63%, respectively, recording positive responses to both depression screening questions, 34% and 60% positive for anxiety, 11% and 71% currently smoking, 6% and 22% feeling they needed to cut down on alcohol, 1% and 48% having used recreational drugs in the past year, and 11% and 65% with problems controlling anger. While many requested help with reducing risk factors, such as smoking (20%) and mental health symptoms (25% to 27%), a total of 35% (57 of 161) wanted help with an identified issue that day. Patients and physicians found the CHAT acceptable, with no patients objecting to any question except the alcohol question (2 objected). Most comments were positive. Conclusion The CHAT allowed efficient identification of 9 risk factors, as well as identification of those wanting help. It could be used to screen all or targeted adult Canadian primary care patients in waiting rooms.