Abstract
BackgroundThe objective of the present study was to provide a complete and detailed report of technical and logistical feasibility problems with the implementation of routine computerized HRQoL measurement at a busy outpatient department of Hepatology that can serve as a tool for future researchers interested in the procedure.MethodsPractical feasibility was assessed by observing problems encountered during the development of the computer program, observing patients' ability to complete the HRQoL questionnaires, monitoring the number of times that patients completed the HRQoL questionnaires and observing logistics at the outpatient department. Patients' reasons for not completing the HRQoL questionnaires were assessed retrospectively by means of a mailed questionnaire. Physicians' attitudes towards the availability of computerized HRQoL information about their patients were assessed by means semi-structured interviews and by means of checklists administered after each consultation with s study participant.ResultsAll physicians (n = 11) and 587 patients agreed to participate in the study. Practical feasibility problems concerned complicated technical aspects of developing a user-friendly computer program and safe data transmission over the Internet, patients' lack of basic computer skills and patients' lack of compliance (completion of questionnaires on only 43% of the occasions). The main reason given for non-compliance was simply forgetting, which seemed to be related to reception employees' passive attitude towards sending patients to the computer. Physicians were generally positive about the instant computerized availability of HRQoL information. They requested the information in 92% of the consultations and found the information useful in 45% of the consultations, especially when it provided them with new information.ConclusionThis study was among the first to implement the complete procedure of routine computerized HRQoL measurements in clinical practice and to subsequently describe the feasibility issues encountered. It was shown that the attitudes of physicians were generally positive. Several barriers towards successful implementation of such a procedure were encountered, and subsequently solutions were provided. Most importantly, when implementing routine computerized HRQoL measurements in clinical practice, assistance of an IT professional for the development of a tailor-made computer program, availability of questionnaires in multiple languages and the use of touch-screen computers to optimise patient participation are essential. Also, all staff of the department concerned should approve of the intervention and consider it as part of standard clinical routine if successful implementation is to be obtained.
Highlights
IntroductionSince 2001, several impact high impact articles have been published on the effectiveness of health related quality of life (HRQoL) measurement in clinical practice, which have presented positive results such as more frequent discussion and identification of HRQoL related problems, improved emotional functioning, improved HRQoL, a decrease in depression, a decrease in debilitating symptoms, and expressed interest in continued use of the information by both physicians and patients [2,3,4,5,6,7]
The objective of the present study was to provide a complete and detailed report of technical and logistical feasibility problems with the implementation of routine computerized health related quality of life (HRQoL) measurement at a busy outpatient department of Hepatology that can serve as a tool for future researchers interested in the procedure
Practical feasibility Problems encountered during the development of the computer program Developing a tailor-made computer program that met our needs with regard to the inclusion of our questionnaires of choice, lay-out, and instant availability of computerized graphical representations of the results to the physicians without violating patients' privacy, proved to be time-consuming and more costly than planned
Summary
Since 2001, several impact high impact articles have been published on the effectiveness of HRQoL measurement in clinical practice, which have presented positive results such as more frequent discussion and identification of HRQoL related problems, improved emotional functioning, improved HRQoL, a decrease in depression, a decrease in debilitating symptoms, and expressed interest in continued use of the information by both physicians and patients [2,3,4,5,6,7] Despite these positive results, standard measurement and feedback of HRQoL has as of yet not been widely implemented in clinical practice. Attitudinal barriers may include health professionals' scepticism of the validity of HRQoL questionnaires, and ability to intervene should the questionnaires reveal any problems [1117]
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