Abstract
BackgroundThe use of Patient Reported Outcome Measures (PROMS) in clinical practice has the potential to promote patient-centred care and improve patients’ quality of life. Individualized PROMs may be particularly helpful in identifying, prioritizing and monitoring health problems of patients with multimorbidity. We aimed to develop an intervention centred around PROMs feedback as part of Primary Care annual reviews for patients with multimorbidity and evaluate its feasibility and acceptability.MethodsWe developed a nurse-oriented intervention including (a) training of nurses on PROMs; (b) administration to patients with multimorbidity of individualized and standardized PROMS; and (c) feedback to both patients and nurses of PROMs scores and interpretation guidance. We then tailored the intervention to patients with two or more highly prevalent conditions (asthma, COPD, diabetes, heart failure, depression, and hip/knee osteoarthritis) and designed a non-controlled feasibility and acceptability evaluation in a convenience sample of primary care practices (5). PROMs were administered and scores fed back immediately ahead of scheduled annual reviews with nurses. Patients and nurses rated the acceptability of the intervention using with a brief survey including optional free comments. Thematic analysis of qualitative interviews with a sample of participating patients (10) and nurses (4) and of survey free comments was conducted for further in-depth evaluation of acceptability. Feasibility was estimated based on rates of participation and completion.ResultsOut of 68 recruited patients (mean age 70; 47% female), 68 completed the PROMs (100%), received feedback (100%) and confirmed nurse awareness of their scores (100%). Most patients (83%) “agreed”/”strongly agreed” that the PROMs feedback had been useful, a view supported by nurses in 89% of reviews. Thematic analysis of rich qualitative data on PROMS administration, feedback and role in annual reviews indicated that both patients and nurses perceived the intervention as acceptable and promising, emphasizing its comprehensiveness and patient-centredness.ConclusionsWe have developed and tested an intervention focusing on routine PROM assessment of patients with multimorbidity in Primary Care. Preliminary findings support its feasibility and a high degree of acceptability from both patients and nurses. The next step is to conduct a full-scale trial for evaluating the effectiveness of the proposed intervention.
Highlights
The use of Patient Reported Outcome Measures (PROMS) in clinical practice has the potential to promote patient-centred care and improve patients’ quality of life
PROMs have traditionally been used most frequently in clinical settings for research purposes and the evaluation of the effectiveness of health interventions [4, 5]. They have been used more recently as part of quality improvement initiatives using generic and intervention specific PROMs, such as the National Health (NHS) England PROMs programme [6] or the International Consortium for Health Outcomes Measurement (ICHOM) [7], both of which focus on evaluations at the health care provider level; or the Patient-Reported Indicator Surveys (PaRIS) initiative of the Organisation for Economic Cooperation and Development (OECD), which aims to elicit measurements at a country level [8]
Development of intervention We developed a nurse-oriented PROMs based patientcentred intervention aimed at people with multimorbidity in general practice focusing on goal setting, prioritization and monitoring
Summary
The use of Patient Reported Outcome Measures (PROMS) in clinical practice has the potential to promote patient-centred care and improve patients’ quality of life. PROMs have traditionally been used most frequently in clinical settings for research purposes and the evaluation of the effectiveness of health interventions [4, 5] They have been used more recently as part of quality improvement initiatives using generic and intervention specific PROMs, such as the NHS England PROMs programme [6] or the International Consortium for Health Outcomes Measurement (ICHOM) [7], both of which focus on evaluations at the health care provider level; or the Patient-Reported Indicator Surveys (PaRIS) initiative of the Organisation for Economic Cooperation and Development (OECD), which aims to elicit measurements at a country level [8]. The evidence is still not conclusive and additional research is needed for the identification of the most promising approaches to PROMs measurement and feedback [11]
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