Table 4 Added Value in the Clinical Encounter – Provider Viewpoints

 Difficult to prioritize

“What would be the hierarchy in what do we choose to address during this particular patient encounter versus what would we delay ... what is your obligation, then, to address everything, which I think is kind of a bigger issue if these are sort of fed back, do you have to address everything?” (Physician)

 Detracts from patient-centeredness

“If I never ask those questions [referring to SU/MH questions] ...that would take away from that development of a [patient-provider] relationship, knowing who they are as a person and what it is that they’re dealing with.” (Physician)

“I will only work in a room where I can share a screen with the patient so I want them to see what I’m seeing ...And I’m not sure how some are going to react [to PRO results]. I’m worried it could actually hurt the doctor patient relationship. One… [providers] may think they don’t have to ask because it’s been asked. Two, patients are going to see. Three, I’m checking boxes again.” (Physician)

 Have information but patient may not be ready to do anything about it

“There is a potential I guess I think of it as little bit of analogous to a testing you know too sensitive in a way, which is that we’re going to screen more, we are going to find more. May or may not mean that the patients wanna do something about it.” (Physician Assistant)

 Compelled to act

“I think we would all feel compelled to that oh, now I’ve seen this, I really need to do something about this.” (Physician)

 Knowing severity helps set visit priorities

“I see severe I’m thinking, you know, we really need to spend a lot of time on this and if it’s moderate, I would give them a referral, but I think I might make different clinical positions depending on if I actually had an official screen for severity.” (Physician)

 Springboard for discussion with patient

“You know, it’s kind of on the table and I can say you know, I’ve looked over your response forms and I’ve noticed these things, you know, what do you think? It looks like things are going well here, but maybe not here. You’ve talked...you haven’t told me about this recent drug use.” (Nurse Practitioner)

“Look, we’ve gone through all of this stuff, you may or may not have talked to your doctor about it… Are there any of these you want to talk to your doctor about? Because then, it’s patient driven, it’s patient centered” (Physician).

“And it just opens up the opportunity to again, talk about the availability of resources within the clinic to help better address that.” (Nurse Practitioner).

 Improves efficiency

“It answers questions for me that I than frankly don’t have to initially ask.” (Physician)

 Fills gap in practice

“So when I think standardization of questions that can summarize things for you in a very busy clinic where you have 30 min to get the evaluation done ...if it were done systematically at X intervals, for example, it would be very useful ... I see it as an opportunity to enhance my assessment of the patient and if ...there was something that was detected, then I could be more aggressive in approaching it” (Nurse Practitioner)

 May capture issues that were previously undetected

“I think if you can actually pick up undiagnosed depression or undiagnosed anxiety and get someone into treatment for that, there’s actually a real value to actually having this screening and then being able to make the appropriate referral.” (Physician)

“I think these questions are designed to try and tease out the people who are being over or under expressive on that [referring to the depression and anxiety standardized questionnaires]...I think sometimes those are harder questions as a clinician to ask” (Nurse Practitioner).

“Having some other process...so picking up new problems, that’s very helpful, but when it’s an existing problem...You know I’m worried less about the extreme, which I think we pick up pretty well, but I think...it’s those in the middle where you know, they’re not clinically depressed, but they’re also not quite where they should be” (Physician).

 Standardized questions

“I think it gives a more structured and quantitative way of looking at what people and what they are experiencing, so in that sense, I think it would be helpful.” (Physician)