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Health and Quality of Life Outcomes
Published in: Health and Quality of Life Outcomes 1/2021

Open Access 01-12-2021 | Care | Research

Integrating Patient Reported Outcome Measures (PROMs) into routine nurse-led primary care for patients with multimorbidity: a feasibility and acceptability study

Authors: Ian Porter, Antoinette Davey, Jaheeda Gangannagaripalli, Jonathan Evans, Charlotte Bramwell, Philip Evans, Chris Gibbons, Jose M. Valderas

Published in: Health and Quality of Life Outcomes | Issue 1/2021

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Abstract

Background

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. 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.

Methods

We 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.

Results

Out 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.

Conclusions

We 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.
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Literature
1.
2.
Greenhalgh J, Gooding K, Gibbons E, Dalkin S, Wright J, Valderas J, et al. How do patient reported outcome measures (PROMs) support clinician-patient communication and patient care? A realist synthesis. J Patient Rep Outcomes. 2018;2:42.PubMedPubMedCentralCrossRef
3.
Mead N, Bower P. Patient-centredness: a conceptual framework and review of the empirical literature. Soc Sci Med. 2000;51(7):1087–110.PubMedCrossRef
4.
Black N, Burke L, Forrest CB, Ravens Sieberer UH, Ahmed S, Valderas JM, et al. Patient-reported outcomes: pathways to better health, better services, and better societies. Qual Life Res. 2016;25:1103–12.PubMedCrossRef
5.
Porter I, Gonçalves-Bradley D, Ricci-Cabello I, Gibbons C, Gangannagaripalli J, Fitzpatrick R, et al. Framework and guidance for implementing patient-reported outcomes in clinical practice: evidence, challenges and opportunities. J Comp Eff Res. 2016;5(5):507–19.PubMedCrossRef
6.
7.
8.
Organisation for Economic Co-operation and Development. Putting people at the centre of health care. PaRIS survey of Patients with Chronic Conditions. Paris: OECD Publishing; 2019.
9.
Valderas JM, Alonso J, Guyatt GH. Measuring patient-reported outcomes: moving from clinical trials into clinical practice. Med J Aust. 2008;189(2):93–4.PubMedCrossRef
10.
Valderas JM. Getting impatient about person-centred health care. Eur J Gen Pr. 2013;19(3):141–2.CrossRef
11.
Valderas JM, Kotzeva A, Espallargues M, Guyatt G, Ferrans CE, Halyard MY, et al. The impact of measuring patient-reported outcomes in clinical practice: a systematic review of the literature. Qual Life Res. 2008;17(2):179–93.PubMedCrossRef
12.
13.
14.
Valderas JM, Starfield B, Sibbald B, Salisbury C, Roland M. Defining comorbidity: implications for understanding health and health services. Ann Fam Med. 2009;7(4):357–63.PubMedPubMedCentralCrossRef
15.
Rijken M, Struckmann V, Van Ginneken E. ICARE4EU: the availability of integrated care programmes addressing multi-morbidity in 31 European countries. Eur J Public Health; 2014.
16.
17.
Smith SM, Wallace E, O’Dowd T, Fortin M. Interventions for improving outcomes in patients with multimorbidity in primary care and community settings. Cochrane Database Syst Rev. 2016;3:CD006560.PubMed
18.
Multimorbidity: clinical assessment and management [NICE Clinical Guideline NG56]. London: National Guidelines Centre on behalf of the National Institute for Health and Care Excellence (NICE); 2016.
19.
Valderas JM, Fitzpatrick R, Roland M. Using health status to measure NHS performance: another step into the dark for the health reform in England. BMJ Qual Saf. 2012;21(4):352–3.PubMedCrossRef
20.
Greenhalgh J, Dalkin S, Gooding K, Gibbons E, Wright J, Meads D, et al. Functionality and feedback: a realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care. Heal Serv Deliv Res. 2017;5(2):1–280.CrossRef
21.
Engel GL. The clinical application of the biopsychosocial model. Am J Psychiatry. 1980;137(5):535–44.PubMedCrossRef
22.
Valderas JM. Multimorbidity, not a health condition or complexity by another name. Eur J Gen Pr. 2015;21(4):213–4.CrossRef
23.
Hibbard J, Gilburt H. Supporting people to manage their health: an introduction to patient activation. The King’s Fund; 2014.
24.
Dennis SM, Zwar N, Griffiths R, Roland M, Hasan I, Powell Davies G, et al. Chronic disease management in primary care: from evidence to policy. Med J Aust. 2008;188(8):53.
25.
Greenhalgh J, Dalkin S, Gibbons E, Wright J, Valderas JM, Meads D, et al. How do aggregated patient-reported outcome measures data stimulate health care improvement? A realist synthesis. J Health Serv Res Policy. 2018;23(1):57–65.PubMedCrossRef
26.
27.
Valderas JM, Gangannagaripalli J, Nolte E, Boyd CM, Roland M, Sarria-Santamera A, et al. Quality of care assessment for people with multimorbidity. J Intern Med. 2019;285(3):289–300.PubMed
28.
Muth C, Blom JW, Smith SM, Johnell K, Gonzalez-Gonzalez AI, Nguyen TS, et al. Evidence supporting the best clinical management of patients with multimorbidity and polypharmacy: a systematic guideline review and expert consensus. J Intern Med. 2019;285(3):272–88.PubMed
29.
Porter I, Valderas JM. Development of a feedback form for routine clinical use of PROs in primary care for patients with multimorbidity. Qual Life Res. 2015;24:181–2.
30.
Porter I, Valderas JM. Use of PROs in clinical guidance for the management of chronic conditions in primary care in the United Kingdom. Qual Life Res. 2015;25:75–6.
31.
Greenhalgh J, Gooding K, Gibbons E, Dalkin S, Wright J, Valderas J, et al. How do patient reported outcome measures (PROMs) support clinician-patient communication and patient care? A realist synthesis. J Patient-Reported Outcomes. 2018;2(1):42.CrossRef
32.
Goncalves BDC, Gibbons C, Ricci-Cabello I, Bobrovitz NJH, Gibbons EJ, Kotzeva A, et al. Routine provision of information on patient-reported outcome measures to healthcare providers and patients in clinical practice (Protocol) . Cochrane Database Syst Rev. 2015;(4): Art. No.: CD011589. https://​doi.​org/​10.​1002/​14651858.​CD011589.
33.
Herdman M, Lloyd A, Janssen MF, Kind P, Parkin D, Bonsel G, Badia XGC. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res. 2011;20(10):1727–36.PubMedPubMedCentralCrossRef
34.
Ruta DA, Leng M, Russell IT, MacDonald LMGAM. A new approach to the measurement of quality of life: The patient generated index. Med Care. 1994;32:1109–26.PubMedCrossRef
35.
Davies N, Gibbons E, Fitzpatrick R. A structured review of patient-reported outcome measures for COPD: an update 2009. Oxford: University of Oxford; 2009.
36.
Gibbons E, Fitzpatrick R. A structured review of patient-reported outcome measures for people with asthma: an update 2009. Oxford: University of Oxford; 2009.
37.
Fitzpatrick R, Gibbons E, Mackintosh A. An overview of patient-reported outcome measures for people with anxiety and depression 2009. Oxford: University of Oxford; 2009.
38.
Gibbons E, Fitzpatrick R. A structured review of patient-reported outcome measures for people with diabetes: an update 2009. Oxford: University of Oxforf; 2009.
39.
Mackintosh A, Gibbons E, Fitzpatrick R. A structured review of patient-reported outcome measures for people with heart failure: an update 2009. Oxford: University of Oxford; 2009.
40.
Fitzpatrick R, Bowling A, Gibbons E, Hayward K, Jenkinson C, Mackintosh A, et al. A structured review of patient-reported measures in relation to selected chronic conditions, perceptions of quality of care and carer impact. Oxford: University of Oxford; 2006.
41.
Gangannagaripalli J, Porter I, Bramwell C, Evans J, Gonzalez JR, Valderas JM. Estimating minimum important difference (MID) for chronic disease-specific patient reported outcome measures (PROMs): a systematic review. Qual Life Res. 2016;25:42.
42.
Teddlie C, Yu F. Mixed methods sampling: a typology with examples. Mix Methods Res. 2007;1(1):77–100.CrossRef
43.
NVivo qualitative data analysis Software. QSR Int Pty Ltd. 2015;Version 11.
44.
Ziebland S, McPherson A. Making sense of qualitative data analysis: an introduction with illustrations from DIPEx (personal experiences of health and illness). Med Educ. 2006;40(5):405–14.PubMedCrossRef
45.
Kernick D, Chew-Graham CA, O’Flynn N. Clinical assessment and management of multimorbidity: NICE guideline. Br J Gen Pr. 2017;67(658):235–6.CrossRef
46.
Mitchell C, Dwyer R, Hagan T, Mathers N. Impact of the QOF and the NICE guideline in the diagnosis and management of depression: a qualitative study. Br J Gen Pr. 2011;61(586):279–89.CrossRef
47.
48.
Espallargues M, Valderas JM, Alonso J. Provision of feedback on perceived health status to health care professionals: a systematic review of its impact. Med Care. 2000;38:175–86.PubMedCrossRef
49.
Rabin R, de Charro F. EQ-5D: a measure of health status from the EuroQol Group. Ann Med. 2001;33(5):337–43.PubMedCrossRef
50.
Juniper EF, Guyatt GH, Cox FM, Ferrie PJ, King DR. Development and validation of the Mini Asthma Quality of Life Questionnaire. Eur Respir J. 1999;14:32–8.PubMedCrossRef
51.
Thomas M, Gruffydd-Jones K, Stonham C, Ward S, Macfarlane TV. Assessing asthma control in routine clinical practice: use of the Royal College of Physicians “3 questions.” Prim Care Respir J. 2009;18(2):83–8.PubMedCrossRef
52.
van der Molen T, Willemse BW, Schokker S, Ten Hacken NH, Postma DS, Juniper EF. Development, validity and responsiveness of the Clinical COPD Questionnaire. Heal Qual Life Outcomes. 2003;1(13):1–10.
53.
Gough J. The pathological diagnosis of emphysema. Proc R Soc Med. 1952;45(9):576–7.PubMed
54.
55.
Meadows KA, Abrams C, Sandbaek A. Adaptation of the Diabetes Health Profile (DHP-1) for use with patients with Type 2 diabetes mellitus: psychometric evaluation and cross-cultural comparison. Diabet Med. 2000;17(8):572–80.PubMedCrossRef
56.
Supino PG, Borer JS, Franciosa JA, Preibisz JJ, Hochreiter C, Isom OW, et al. Acceptability and psychometric properties of the Minnesota Living With Heart Failure Questionnaire among patients undergoing heart valve surgery: validation and comparison with SF-36. J Card Fail. 2009;15(3):267–77.PubMedCrossRef
57.
Dawson J, Fitzpatrick R, Carr A, Murray D. Questionnaire on the perceptions of patients about total hip replacement. J Bone Jt Surg Br. 1996;78(2):185–90.CrossRef
58.
Dawson J, Fitzpatrick R, Murray D, Carr A. Questionnaire on the perceptions of patients about total knee replacement. J Bone Jt Surg Br. 1998;80(1):63–9.CrossRef
Metadata
Title
Integrating Patient Reported Outcome Measures (PROMs) into routine nurse-led primary care for patients with multimorbidity: a feasibility and acceptability study
Authors
Ian Porter
Antoinette Davey
Jaheeda Gangannagaripalli
Jonathan Evans
Charlotte Bramwell
Philip Evans
Chris Gibbons
Jose M. Valderas
Publication date
01-12-2021
Publisher
BioMed Central
Keyword
Care
Published in
Health and Quality of Life Outcomes / Issue 1/2021
Electronic ISSN: 1477-7525
DOI
https://doi.org/10.1186/s12955-021-01748-2

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