Integrating Patient Reported Outcome Measures into routine primary care for patients with multimorbidity

Conference: 
SAPC ASM 2017 - Warwick
Talk Code: 
1B.5
Presenter: 
Ian Porter
Co-authors: 
Jose M Valderas, Ian Porter, Jaheeda Gangannagaripalli, Charlotte Bramwell, Phil Evans
Author institutions: 
University of Exeter Medical School, University of Exeter

Problem

Patient Reported Outcome Measures (PROMS) are questionnaires completed by patients to rate their own health. They have the potential to improve quality of life and promote patient centred care, but are currently under-utilised in Primary Care. For patients with multiple conditions (multimorbidity) the use of individualised and standardised PROMs may help in supporting prioritisation of patients’ health problems and monitoring their health conditions. We aimed to test the feasibility of implementing routine PROMs feedback as part of Primary Care annual reviews for patients with multimorbidity.

Approach

Patients with two or more conditions (asthma, COPD, diabetes, heart failure, depression, and hip and/or knee osteoarthritis) completed generic, condition specific and individualised PROs immediately ahead of scheduled annual reviews. Personalised PRO summaries were provided to patients and clinicians, focussing on: a) direction and range of theoretical scores; b) median scores in relevant UK samples; c) recommended management of conditions based on results (based on systematic reviewing clinical practice guidelines and quality indicators for recommended care). Participating patients and clinicians rated the acceptability of the intervention with a brief questionnaire and provided comments. At the end of the study qualitative interviews were also conducted with participating patients (10) and clinicians (5) to provide a more detailed evaluation.

Findings

All 68 recruited patients completed the relevant PRO measures, and received personalized feedback, ahead of their review (mean age 70; 47% female; median number of conditions 2 (most common combinations: diabetes/osteoarthritis (13%), diabetes/COPD (12%)). PROMs scores were similar to available published scores in Primary Care UK samples. The most common health priority identified by participants was “physical exercise”. 90% of patients agreed/strongly agreed that the PROMs summary had been a useful way of prioritising health care. Clinicians agreed/strongly agreed that the feedback was helpful for conducting the review for 89% of patients. Answers from open ended questions indicated that the patient centred nature of the intervention was valued by both patients (“I felt listened to and responded to”) and clinicians (“It was nice to make the focus of the review the patient and not the tasks”). Analysis from qualitative interviews indicated that both patients and clinicians viewed the PROMs review in a positive light, considering it to be comprehensive and patient centred.

Consequences

This is the first evaluation of the role of routine PROs assessment of patients with multimorbidity in Primary Care. Preliminary findings suggest a high degree of acceptability from both patients and clinicians. We will refine recruitment pathways, research instruments and ways in which they are administered, based on identified barriers and facilitators, helping to inform a more patient focused General Practice. Now that we have tested for feasibility and acceptability our aim is to conduct a full scale trial where we can measures outcomes as part of ongoing routine care.

Submitted by: 
Jose M Valderas
Funding acknowledgement: 
NIHR Clinician Scientist Award NIHR/CS/010/024 "Improving the management of long term conditions with the clinical use of patient reported outcome measures in Primary Care"