Abstracts

Rationale: A key barrier preventing anxiety and depression screening by epileptologists is time required to screen. Strategies to encourage patient self-completion of screeners prior to visits are needed.

Methods: This parallel group pragmatic randomized trial compared different pre-visit anxiety and depression screener delivery methods among consecutive adults scheduled for tertiary epilepsy center visits. Seven days before a scheduled visit, baseline demographics and medical history were collected from the electronic health record (EHR) via Research Electronic Database Capture (REDCap) integration tools. Patients were then randomized to one of four pre-visit screener delivery methods, stratified by presence of an antidepressant prescription. Screener delivery methods included: electronic health record (EHR) portal, EHR portal plus portal message instructing how to access questionnaires, direct email with link to questionnaires in REDCap, and text message with REDCap questionnaire link. The Generalized Anxiety Disorder-7 and Neurological Disorders Depression Inventory-Epilepsy screeners were used. Prior to first screener, a brief information consent was presented indicating responses may be used for research and neurologist may be alerted to screener results. Message and consent wording was formulated in collaboration with patient stakeholders. Screener results completed in REDCap were transferred to EHR before scheduled visit. Planned sample size was 880. Point estimates for proportion of screeners completed by delivery method were calculated, along with descriptive statistics. Unfortunately, the text message arm was compromised by a technical issue at the level of text service carrier, arising after successful pre-study testing and preventing text message delivery, despite REDCap records suggesting successful text delivery.

Results: The total sample of 880 individuals had mean age 42.7 years, was 55% female, 73% White, 20% Black and 5.2% Hispanic or Latino. The sample demographics were well-balanced across groups (Table 1). Overall, 29% had a baseline antidepressant prescription and 78% had an epilepsy diagnosis based on EHR problem list or review of prior neurology notes. Based on communication preferences in the EHR/institutional policies, 21% did not have a patient portal account, 8.8% could not receive email, 23% could not receive texts, and 6.5% could not receive any modality. Overall pre-visit screener completion was 13% in the EHR portal group, 19% in the EHR portal with message group, and 15% in the email group. Among those able to receive the randomized modality, completion proportions were 16%, 24%, and 16% respectively. Patients allocated to email or EHR portal with message completed screening earlier in the 7-day follow-up timeframe than the EHR portal group (Table 2).

Conclusions: The highest screener completion rate was observed in the patient portal with message group. Direct email messaging to encourage pre-visit screener completion did not appear to result in better screening rates than patient portal-based strategies.

Funding: NIH R03TR004251