Understanding the Utility of Preparticipation Physical Evaluations (PPE)

Background: The preparticipation physical evaluation (PPE) has long been the point of
primary care contact for many adolescents. In 2019, new mental health screening questions
were added. There is no data on if providers are appropriately following the screening
guidelines for the new mental health questions during the PPE.

Methods: A cross-sectional study was conducted via a Qualtrics survey. Physicians were
recruited to participate by email recruitment. Physicians were presented with two different
mock patient encounters, Scenario 1 (Anxiety and Depression) and Scenario 2 (Depression),
where they were asked to determine the patient's screening results. The physicians then
explained how they would proceed with positive screening answers.

Results: A total of 58 physicians completed this study. In Scenario 1, 91% (n=53) physicians
correctly interpreted the scenario. No differences were detected by practice type, years in
practice, number of PPEs conducted per year, and review of the text in which the PPE guidelines
originated in those who correctly identified this scenario versus those who did not. In Scenario
2, 62% (n=36) physicians correctly interpreted the scenario. The only difference was the median
number of years in practice was lower for those who correctly diagnosed this scenario (11
[5,24.5]) compared to those who incorrectly diagnosed this scenario (23 [15, 30]), p=0.01

Conclusion: The Patient Health Questionnaire Version 4 (PHQ-4) was added to the PPE to provide a feasible and valid tool to screen for anxiety and depression in a busy medical setting. Our study shows that the vast majority who utilize these questions can correctly interpret the screening results. In Scenario 2, 20 of the 22 who incorrectly interpreted this scenario said that patient screened positive for both anxiety and depression, rather than just depression. Due to how significant mental health concerns are in this age group, and how similar a physician’s next steps are in the clinic to further investigate potential anxiety or depression concerns, the consequence of this seems minimal.