Top

Published in:

Open Access 01-12-2018 | Research article

Exploring organisational mechanisms in PRO-based follow-up in routine outpatient care - an interpretive description of the clinician perspective

Authors: Caroline Trillingsgaard Mejdahl, Liv Marit Valen Schougaard, Niels Henrik Hjollund, Erik Riiskjær, Kirsten Lomborg

Published in: BMC Health Services Research | Issue 1/2018

Abstract

Background

Patient-reported outcome (PRO)-based follow-up is a new model of service delivery, where PRO measures are used as the very basis for demand-driven outpatient follow-up in patients with chronic diseases. Adopting the clinicians’ perspective, we aimed to explore what happens when PRO-based follow-up is implemented in routine clinical practice. We also aimed to identify organisational mechanisms related to PRO-based follow-up.

Methods

The methodological approach of this interview study is interpretive description, informed by a perspective of critical realism. Semi-structured interviews were conducted with 13 clinicians (eight nurses and five physicians) working with PRO-based follow-up in outpatient care for epilepsy in the Central Denmark Region.

Results

PRO-based follow-up gave rise to ambivalence in clinicians. Seen from the clinicians’ perspective, PRO-based follow-up could both increase and decrease the quality of follow-up. Moreover, PRO-based follow-up both enhanced and impaired clinicians’ work experiences. Additionally, the clinicians used strategies to ease some of the perceived disadvantages. The clinicians did extra tasks and worked around the scope of PRO-based follow-up. Thus, clinicians constituted a professional buffer as they deflected some of the negative mechanisms associated with PRO-based follow-up.

Conclusions

As a model of a service delivery, PRO-based follow-up is highly dependent on the clinicians’ day-to-day management of the system, and mechanisms related to routine use of PRO measures in outpatient follow-up are complex. Paying attention to the organisational settings is critical for PRO-based follow-up to improve quality of care and enhance patient-centred care.

Available only for authorised users

Voshaar MAHO, van de Laar MAFJ. PROMs and quality of care. In: El Miedany Y, editor. Patient reported outcome measures in rheumatic diseases. Cham: Springer; 2016.

Appleby J, Devlin NJ, Parkin DW. Using patient reported outcomes to improve health care: Chichester. West Sussex: John Wiley & Sons Inc.; 2016.

European Commission. Eurobarometer qualitative study. Aggregate Report Patient involvement. 2012;2012

Sacristán JA, Aguarón A, Avendaño-Solá C, Garrido P, Carrión J, Gutiérrez A, Kroes R, Flores A. Patient involvement in clinical research: why, when, and how. Patient preference and adherence. 2016;10:631. https://doi.org/10.2147/PPA.S104259.CrossRefPubMedPubMedCentral

Chewning B, Bylund CL, Shah B, Arora NK, Gueguen JA, Makoul G. Patient preferences for shared decisions: a systematic review. Patient Educ Couns. 2012;86(1):9–18. https://doi.org/10.1016/j.pec.2011.02.004.CrossRefPubMed

U.S. Department of Health and Human Services FDA. Guidance for industry: patient-reported outcome measures: use in medical product development to support labeling claims: draft guidance. Health Qual Life Outcomes. 2006;4:1–20. https://doi.org/10.1186/1477-7525-4-79.CrossRef

Dawson J, Doll H, Fitzpatrick R, Jenkinson C, Carr AJ. The routine use of patient reported outcome measures in healthcare settings. BMJ. 2010;340:c186.CrossRefPubMed

Valderas JM, Alonso J. Patient reported outcome measures: a model-based classification system for research and clinical practice. Qual Life Res. 2008;17(9):1125. https://doi.org/10.1007/s11136-008-9396-4.CrossRefPubMed

Greenhalgh J, Dalkin S, Gooding K, Gibbons E, Wright J, Meads D, Black N, Valderas JM, Pawson R. Functionality and feedback: a realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care. Health Services and Delivery Research. 2017;5(2):1–280. https://doi.org/10.3310/hsdr05020.CrossRef

10.

Hjollund NHI, Larsen LP, Biering K, Johnsen SP, Riiskjær E, Schougaard LM. Use of patient-reported outcome (PRO) measures at group and patient levels: experiences from the generic integrated PRO system, WestChronic. Interactive J Med Res. 2014;3(1)e5.

11.

Greenhalgh J. The applications of pros in clinical practice: what are they, do they work, and why? Qual Life Res. 2009;18(1):115–23. https://doi.org/10.1007/s11136-008-9430-6.CrossRefPubMed

12.

Porter I, Gonçalves-Bradley D, Ricci-Cabello I, Gibbons C, Gangannagaripalli J, Fitzpatrick R, Black N, Greenhalgh J, Valderas JM. Framework and guidance for implementing patient-reported outcomes in clinical practice: evidence, challenges and opportunities. J Comparative Effectiveness Res. 2016;5(5):507–19. https://doi.org/10.2217/cer-2015-0014.CrossRef

13.

Chen J, Ou L, Hollis SJ. A systematic review of the impact of routine collection of patient reported outcome measures on patients, providers and health organisations in an oncologic setting. BMC Health Serv Res. 2013;13(1):211. https://doi.org/10.1186/1472-6963-13-211.CrossRefPubMedPubMedCentral

14.

Kotronoulas G, Kearney N, Maguire R, Harrow A, Di Domenico D, Croy S, MacGillivray S. What is the value of the routine use of patient-reported outcome measures toward improvement of patient outcomes, processes of care, and health service outcomes in cancer care? A systematic review of controlled trials. J Clin Oncol Off J Am Soc Clin Oncol. 2014;32(14):1480–510. https://doi.org/10.1200/JCO.2013.53.5948. CrossRef

15.

Valderas JM, Kotzeva A, Mea E. The impact of measuring patient-reported outcomes in clinical practice: a systematic review of the literature. Qual Life Res. 2008;17(2):179–93. https://doi.org/10.1007/s11136-007-9295-0.CrossRefPubMed

16.

Regeringen DR. Aftale om regionernes økonomi for 2017 (agreement on the associations of Danish Regions' economy in 2017) (in Danish). . 2016.

17.

TrygFonden og ViBIS. Program PRO Anvendelse af PRO-data i kvalitetsudviklingen af det danske sundhedsvæsen - anbefalinger og vidensgrundlag. 2016.

18.

Sundheds- Ældreministeriet. Sundheds- og Ældreministeriet: PRO i Danmark - Oplæg for Dialogpanelet (PRO in Denmark - Presentation for The Dialog Panel) (In Danish). file:///C:/Users/au325834/AppData/Local/Microsoft/Windows/INetCache/IE/GRZBWD81/Oplaeg-for-Dialogpanelet-PRO-i-Danmark-NS.pdf. Accessed 20 Feb 2018.

19.

Anonymous AmbuFlex. http://ambuflex.dk/en/about-ambuflex/. Accessed 7 July 2018.

20.

Miller D, Steele Gray C, Kuluski K, Cott C. Patient-Centered Care and Patient-reported measures: Let's look before we leap. The patient. 2015;8(4):293–9. https://doi.org/10.1007/s40271-014-0095-7. CrossRefPubMed

21.

Mejdahl C, Nielsen B, Hjøllund NH, Lomborg K. Use of patient-reported outcomes in outpatient settings as a means of patient involvement and self-management support - a qualitative study of the patient perspective. Eur J for Person Centered Healthcare. 2016;4(2):359–67.CrossRef

22.

Oliver C. Strategic responses to institutional processes. Acad Manag Rev. 1991;16(1):145–79. https://doi.org/10.5465/AMR.1991.4279002. CrossRef

23.

Sahlin K, Circulating Ideas WL. Imitation, translation and editing. In: Greenwood R, Oliver C, Suddaby R, Sahlin K, editors. The SAGE handbook of organizational institutionalism. London: SAGE Publications Ltd; 2008. p. 218–42.CrossRef

24.

Czarniawska B, Joerges B. Travels of ideas. In: Czarniawska B, Sevón G, editors. Translating organizational change. Berlin: Walter de Gruyter; 1996. p. 13–37.CrossRef

25.

Schougaard L, Larsen LP, Jessen A, Sidenius P, Dorflinger L, de Thurah A, Hjollund NH. AmbuFlex: tele-patient-reported outcomes (telePRO) as the basis for follow-up in chronic and malignant diseases. Qual Life Res. 2016;25(3):525–34. https://doi.org/10.1007/s11136-015-1207-0.CrossRefPubMedPubMedCentral

26.

Boyce MB, Browne JP, Greenhalgh J. The experiences of professionals with using information from patient-reported outcome measures to improve the quality of healthcare: a systematic review of qualitative research. BMJ quality & safety. 2014; https://doi.org/10.1136/bmjqs-2013-002524.

27.

Schepers SA, Haverman L, Zadeh S, Grootenhuis MA, Wiener L. Healthcare professionals’ preferences and perceived barriers for routine assessment of patient-reported outcomes in pediatric oncology practice: moving toward international processes of change. Pediatr Blood Cancer. 2016;63(12):2181–8.CrossRefPubMed

28.

Thorne S. Interpretive description : qualitative research for applied practice. 2nd ed. New York, NY: Routledge; 2016.

29.

Danermark B. Explaining society : critical realism in the social sciences. London: Routledge; 2002.

30.

Porter S. Critical realism: a social theory for evidence-based nursing. In: Lipscomb M, editor. Social theory and nursing: Routledge; 2017. p. 76.

31.

Schougaard LM, Mejdahl CT, Petersen KH, Jessen A, De Thurah A, Sidenius P, Lomborg K, Hjollund NH. Effect of patient-initiated versus fixed-interval telePRO-based outpatient follow-up: study protocol for a pragmatic randomised controlled study. BMC Health Serv Res. 2017;17(1):83. https://doi.org/10.1186/s12913-017-2015-8.CrossRefPubMedPubMedCentral

32.

QSR International Pty Ltd. NVivo qualitative data analysis Software. Version 11, vol. 11; 2016. p. 12–21.

33.

Pols J, Moser I. Cold technologies versus warm care? On affective and social relations with and through care technologies. Alter - Eur J of Disability Res, Revue européen de recherche sur le handicap. 2009;3(2):159–78. https://doi.org/10.1016/j.alter.2009.01.003.CrossRef

34.

Miller EA. The technical and interpersonal aspects of telemedicine: effects on doctor–patient communication. J Telemed Telecare. 2003;9(1):1–7.CrossRefPubMed

35.

Onor ML, Misan S. The clinical interview and the doctor-patient relationship in telemedicine. Telemedicine J and e-health : the official journal of the American Telemedicine Association. 2005; https://doi.org/10.1089/tmj.2005.11.102.

36.

Pols J. The heart of the matter. About good nursing and telecare Health care analysis : HCA. 2010; https://doi.org/10.1007/s10728-009-0140-1.

37.

Westphal J, Ranjay G, Shortell S. Customization or conformity? An institutional and network perspective on the content and consequences of TQM adoption. Adm Sci Q. 1997;1:366–94.CrossRef

Title: Exploring organisational mechanisms in PRO-based follow-up in routine outpatient care - an interpretive description of the clinician perspective
Authors: Caroline Trillingsgaard Mejdahl
Liv Marit Valen Schougaard
Niels Henrik Hjollund
Erik Riiskjær
Kirsten Lomborg
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Health Services Research / Issue 1/2018
Electronic ISSN: 1472-6963
DOI: https://doi.org/10.1186/s12913-018-3352-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Exploring organisational mechanisms in PRO-based follow-up in routine outpatient care - an interpretive description of the clinician perspective

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2018

Patients’ perspectives of acceptability of ART, TB and maternal health services in a subdistrict of Johannesburg, South Africa

Comparison of audio vs. audio + video for the rating of shared decision making in oncology using the observer OPTION5 instrument: an exploratory analysis

Evolution of public hospitals expenditure by healthcare area in the Spanish National Health System: the determinants to pay attention to

Urban-rural disparities in health care utilization among Chinese adults from 1993 to 2011

The impact of global budget on the diffusion of innovations: the example of positron emission tomography in Taiwan

Comparing the needs and utilization of health services between urban residents and rural-to-urban migrants in China from 2012 to 2016