Tu1096 Perceptions of Patient-Centered Care Among Veterans With Gastroesophageal Reflux Disease on Proton Pump Inhibitor Therapy

Abstract

Background. Limited data exist describing patient-centered care (PCC) outcomes among patients with gastroesophageal reflux disease (GERD) on proton pump inhibitor (PPI) therapy. The study purpose was to use a patient-reported outcome measure to explore perceptions of care among patients with GERD on PPI therapy. Methods. The Center for Evaluation of Practices and Experiences of Patient Centered Care (CEPEP) is a VA funded project to evaluate various PCC outcomes, using mailed validated surveys to Veterans with chronic conditions seen across 8 nationally representative VA centers. We analyzed the Patient Assessment of Care for Chronic Conditions (PACIC) in a subset of Veterans diagnosed with GERD and prescribed PPI therapy. The PACIC assesses patient views of the chronic care received and is organized into five subscales that address elements of patient-centered care as perceived by patients (Patient Activation, Delivery System Design/Decision Support, Goal Setting, Problem Solving/Contextual Counseling, and Follow-up/Coordination). Overall summary and subscale scores range from 1-5; higher scores indicate higher subjective ratings of health care received. We used descriptive statistics to describe patient characteristics and assess if PPI dosing (standard vs high dose) or duration of therapy (short term = 6 mo) was associated with perception of care received. Results. Veteran patients with GERD on PPI (n=501) were mostly male (94.6%), white/non-Hispanic (70.6%), and, on average, 68 years of age. 67.5% of respondents reported having 3 or more chronic conditions. Nearly all respondents (99.8%) reported having one or more recent outpatient visits; 24.8% reported one or more recent ER visits. 53.1% had high total daily dose initial PPI prescriptions; 46.9% had standard total daily dose initial prescriptions. A majority of respondents (87.6%) reported long-term PPI use. The mean PACIC summary score for the entire sample was 3.01 (SD=1.16). 39.0% of respondents achieved an overall PACIC summary score of 3.5 or higher. Respondents achieved highest scores overall in the Delivery System Design/Decision Support (3.36, SD=1.19) and Patient Activation subscales (3.23, SD=1.26); lowest scores were achieved in the Follow-up/Coordination subscale (2.56, SD=1.26) and the Goal Setting/Tailoring subscale (2.97, SD=1.27).Mean subscale score for Problem Solving/ Contextual Counseling was 3.21, SD=1.35. There were no differences in PACIC scores by PPI dose or duration of therapy. Conclusions. Veterans with GERD on PPI therapy were generally activated in their care and perceived care to be supportive in enhancing their own understanding of care. However, further efforts are needed to explore if PCC outcomes are associated with GERD symptom control, particularly in areas of follow-up support, tailored goal setting and coordination of care.