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Rasmussen SP, Schougaard LMV, Hjøllund NH, Christiansen DH. Patient-reported outcome measures as determinants for the utilization of health care among outpatients with epilepsy: a prognostic cohort study. J Patient Rep Outcomes 2023; 7:103. [PMID: 37861867 PMCID: PMC10589170 DOI: 10.1186/s41687-023-00641-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 10/02/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Patient-reported outcome (PRO) measures can inform clinical decision making and planning of treatment in the health care system. The aim of this study was to examine whether patient-reported health domains influence the use of health care services in outpatients with epilepsy. METHODS This was a prognostic cohort study of 2,426 epilepsy outpatients referred to PRO-based follow-up at the Department of Neurology, Aarhus University Hospital, Denmark. Patients filled out a questionnaire covering health literacy areas, self-efficacy, well-being and general health. The main outcome was a record of contact to the epilepsy outpatient clinic, inpatient ward and/or emergency room within 1 year, retrieved from health register data. Associations were analysed by multivariable binomial logistic regression. RESULTS A total of 2,017 patients responded to the questionnaire and 1,961 were included in the final analyses. An outpatient contact was more likely among patients with very low health literacy ('social support'): odds ratio (OR) 1.5 (95% CI: 1.1-2.1), very low and low self-efficacy: OR 1.7 (95% CI: 1.2-2.3) and OR 1.4 (95% CI: 1.0-1.8), low and medium well-being: OR 2.2 (95% CI: 1.6-3.0) and OR 1.4 (95% CI: 1.1-1.9), and patients rating their general health as fair: OR 2.8 (95% CI: 1.7-4.6). Inpatient contact and emergency room contact were associated with the health domains of self-efficacy and general health. CONCLUSIONS PRO questionnaire data indicated that patients with low health literacy ("social support"), well-being, self-efficacy and self-rated general health had an increased use of health care services at 1 year.These results suggest that PRO measures may provide useful information in relation to the possibility of proactive efforts and prevention of disease-related issues and to help identify efficiency options regarding resource utilization.
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Affiliation(s)
- Stine Primdahl Rasmussen
- Department of Occupational Medicine, Danish Ramazzini Centre, Gødstrup Hospital, Hospitalsparken 15, Herning, 7400, Denmark
- AmbuFlex - Center for Patient-reported Outcomes, Central Denmark Region, Gødstrup Hospital, Møllegade 16, Herning, 7400, Denmark
| | - Liv Marit Valen Schougaard
- AmbuFlex - Center for Patient-reported Outcomes, Central Denmark Region, Gødstrup Hospital, Møllegade 16, Herning, 7400, Denmark
| | - Niels Henrik Hjøllund
- AmbuFlex - Center for Patient-reported Outcomes, Central Denmark Region, Gødstrup Hospital, Møllegade 16, Herning, 7400, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Blvd. 82, Aarhus, 8200, Denmark
| | - David Høyrup Christiansen
- Department of Occupational Medicine, Danish Ramazzini Centre, Gødstrup Hospital, Hospitalsparken 15, Herning, 7400, Denmark.
- Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Blvd. 82, Aarhus, 8200, Denmark.
- Elective Surgery Centre, Silkeborg Regional Hospital, Falkevej 1A, Silkeborg, 8600, Denmark.
- Centre for Research in Health and Nursing, Research, Regional Hospital Central Jutland, Heibergs Allé 2K, Viborg, 8800, Denmark.
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Karalliedde J, French O, Burnhill G, Malhotra B, Spellman C, Jessel M, Ayotunde A, Newcombe L, Smith A, Thomas S, Rajasingam D. A pragmatic digital health informatics based approach for aiding clinical prioritisation and reducing backlog of care: A study in cohort of 4022 people with diabetes. Diabetes Res Clin Pract 2023; 203:110834. [PMID: 37478978 DOI: 10.1016/j.diabres.2023.110834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/17/2023] [Accepted: 07/17/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND AND AIMS The backlog of care in resource stretched healthcare systems requires innovative approaches to aid clinical prioritisation. Our aim was to develop an informatics tool to identify and prioritise people with diabetes who are likely to deteriorate whilst awaiting an appointment to optimise clinical outcomes and resources. MATERIALS AND METHODS Using data from electronic health care records we identified 6 risk-factors that could be addressed in 4022 people (52% male, 30% non-Caucasian) with diabetes attending a large university hospital in London. The risk-factors were new clinical events/data occurring since their last routine clinic visit. To validate and compare data-led prioritisation tool to a traditional 'clinical approach' a sample of 450 patients were evaluated. RESULTS Of the 4022 people, 549 (13.6%) were identified as having one or more risk events/factors. People with risk were more likely to be non-Caucasian and had greater socio-economic deprivation. Taking clinical prioritisation as the gold standard, informatics tool identified high risk patients with a sensitivity of 83% and lower risk patients with a specificity of 81%. An operational pilot pathway over 3 months using this approach demonstrated in 101 high risk people that 40% received interventions/care optimisation to prevent deterioration in health. CONCLUSION A pragmatic data-driven method identifies people with diabetes at highest need for clinical prioritisation within restricted resources. Health informatics systems such as our can enhance care and improve operational efficiency and better healthcare delivery for people with diabetes.
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Affiliation(s)
- J Karalliedde
- Guy's & St Thomas' NHS Foundation Trust London UK; School of Cardiovascular Medicine and Sciences, King's College London, London UK.
| | - O French
- Factor 50 Limited, Nottingham UK
| | | | - B Malhotra
- Guy's & St Thomas' NHS Foundation Trust London UK
| | - C Spellman
- Guy's & St Thomas' NHS Foundation Trust London UK
| | - M Jessel
- Guy's & St Thomas' NHS Foundation Trust London UK
| | - A Ayotunde
- Guy's & St Thomas' NHS Foundation Trust London UK
| | | | - A Smith
- Factor 50 Limited, Nottingham UK
| | - S Thomas
- Guy's & St Thomas' NHS Foundation Trust London UK
| | - D Rajasingam
- Guy's & St Thomas' NHS Foundation Trust London UK
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Hjollund NHI, Larsen LP, de Thurah AL, Grove BE, Skuladottir H, Linnet H, Friis RB, Johnsen SP, May O, Jensen AL, Hansen TK, Taarnhøj GA, Tolstrup LK, Pappot H, Ivarsen P, Dørflinger L, Jessen A, Sørensen NT, Schougaard LMV, Team TA. Patient-reported outcome (PRO) measurements in chronic and malignant diseases: ten years' experience with PRO-algorithm-based patient-clinician interaction (telePRO) in AmbuFlex. Qual Life Res 2023; 32:1053-1067. [PMID: 36639598 PMCID: PMC10063508 DOI: 10.1007/s11136-022-03322-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Patient-reported Outcome (PRO) measures may be used as the basis for out-patient follow-up instead of fixed appointments. The patients attend follow-up from home by filling in questionnaires developed for that specific aim and patient group (telePRO). The questionnaires are handled in real time by a specific algorithm, which assigns an outcome color reflecting clinical need. The specific questionnaires and algorithms (named solutions) are constructed in a consensus process with clinicians. We aimed to describe AmbuFlex' telePRO solutions and the algorithm outcomes and variation between patient groups, and to discuss possible applications and challenges. METHODS TelePRO solutions with more than 100 processed questionnaires were included in the analysis. Data were retrieved together with data from national registers. Characteristics of patients, questionnaires and outcomes were tabulated for each solution. Graphs were constructed depicting the overall and within-patient distribution of algorithm outcomes for each solution. RESULTS From 2011 to 2021, 29 specific telePRO solutions were implemented within 24 different ICD-10 groups. A total of 42,015 patients were referred and answered 171,268 questionnaires. An existing applicable instrument with cut-off values was available for four solutions, whereas items were selected or developed ad hoc for the other solutions. Mean age ranged from 10.7 (Pain in children) to 73.3 years (chronic kidney disease). Mortality among referred patients varied between 0 (obesity, asthma, endometriosis and pain in children) and 528 per 1000 patient years (Lung cancer). There was substantial variation in algorithm outcome across patient groups while different solutions within the same patient group varied little. DISCUSSION TelePRO can be applied in diseases where PRO can reflect clinical status and needs. Questionnaires and algorithms should be adapted for the specific patient groups and clinical aims. When PRO is used as replacement for clinical contact, special carefulness should be observed with respect to patient safety.
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Affiliation(s)
- Niels Henrik I Hjollund
- AmbuFlex - Center for Patient-Reported Outcomes, Central Denmark Region, Gødstrup Hospital, Herning, Denmark.
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Louise Pape Larsen
- AmbuFlex - Center for Patient-Reported Outcomes, Central Denmark Region, Gødstrup Hospital, Herning, Denmark
| | | | - Birgith Engelst Grove
- AmbuFlex - Center for Patient-Reported Outcomes, Central Denmark Region, Gødstrup Hospital, Herning, Denmark
| | | | - Hanne Linnet
- Department of Oncology, Gødstrup Hospital, Herning, Denmark
| | | | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ole May
- Department of Medicine, Gødstrup Hospital, Herning, Denmark
| | | | | | - Gry Assam Taarnhøj
- Department of Oncology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Lærke Kjær Tolstrup
- Department of Oncology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Helle Pappot
- Department of Oncology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Per Ivarsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Anne Jessen
- AmbuFlex - Center for Patient-Reported Outcomes, Central Denmark Region, Gødstrup Hospital, Herning, Denmark
| | - Nanna Toxvig Sørensen
- AmbuFlex - Center for Patient-Reported Outcomes, Central Denmark Region, Gødstrup Hospital, Herning, Denmark
| | - Liv Marit Valen Schougaard
- AmbuFlex - Center for Patient-Reported Outcomes, Central Denmark Region, Gødstrup Hospital, Herning, Denmark
| | - The AmbuFlex Team
- AmbuFlex - Center for Patient-Reported Outcomes, Central Denmark Region, Gødstrup Hospital, Herning, Denmark
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Nielsen CL, Clemensen J, Beier CPP. Feasibility and acceptability of a virtual diagnostic sleep disorders service: A qualitative study. J Telemed Telecare 2023:1357633X221149457. [PMID: 36659813 DOI: 10.1177/1357633x221149457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION The electronic collection of patient data is used for a large variety of conditions. The boundaries of its use in initial diagnostics and the extent to which it can replace specialist contact, however, remain vague. Our newly developed virtual diagnostic process for common sleep disorders involves digital questionnaire administration, neurophysiological diagnostic studies, and virtual consultation with a sleep specialist. In this study, we evaluated patients' virtual diagnostic process experiences as part of a full evaluation of this process. METHODS Patients who completed the virtual diagnostic process participated in online semi-structured interviews based on the following criteria: age ≥ 18 years, no obvious cognitive deficits, and access to the internet. Patients who did not complete the virtual diagnostic process were contacted by telephone and given the opportunity to explain why. RESULTS Of the 24 patients included, 14 completed the virtual diagnostic process. Most participants understood the concept of the virtual diagnostic process, could navigate the process, and felt that the combined use of a questionnaire and virtual consultation was meaningful. Although participants could provide information as free text, the simplified closed questions, required for diagnostic classification, triggered feelings of insecurity and the inability to sufficiently describe symptoms, thereby evoking concern. All patients deemed the complementary personal contact important. DISCUSSION The findings demonstrate that the virtual diagnostic process is feasible and highly accepted by most patients. However, (virtual) personal (telephone or video) contact is mandatory to address patients' concerns. The virtual diagnostic process application evaluated here likely represents the outer limit of the use of electronic data collection in virtual diagnostic procedures.
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Affiliation(s)
- Camilla Littau Nielsen
- Hans Christian Andersen Children's Hospital, 11286Odense University Hospital, Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Jane Clemensen
- Hans Christian Andersen Children's Hospital, 11286Odense University Hospital, Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
- Center for Innovative Medical Technology, 11286Odense University Hospital, Odense C, Denmark
| | - Christoph Patrick P Beier
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
- Center for Innovative Medical Technology, 11286Odense University Hospital, Odense C, Denmark
- Department of Neurology, 11286Odense University Hospital, Odense C, Denmark
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El Benny M, Kabakian-Khasholian T, El-Jardali F, Bardus M. Application of the eHealth Literacy Model in Digital Health Interventions: Scoping Review. J Med Internet Res 2021; 23:e23473. [PMID: 34081023 PMCID: PMC8212628 DOI: 10.2196/23473] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/20/2020] [Accepted: 04/14/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Digital health interventions (DHIs) are increasingly being adopted globally to address various public health issues. DHIs can be categorized according to four main types of technology: mobile based, web based, telehealth, and electronic health records. In 2006, Norman and Skinner introduced the eHealth literacy model, encompassing six domains of skills and abilities (basic, health, information, scientific, media, and computer) needed to effectively understand, process, and act on health-related information. Little is known about whether these domains are assessed or accounted for in DHIs. OBJECTIVE This study aims to explore how DHIs assess and evaluate the eHealth literacy model, describe which health conditions are addressed, and which technologies are used. METHODS We conducted a scoping review of the literature on DHIs, based on randomized controlled trial design and reporting the assessment of any domain of the eHealth literacy model. MEDLINE, CINAHL, Embase, and Cochrane Library were searched. A duplicate selection and data extraction process was performed; we charted the results according to the country of origin, health condition, technology used, and eHealth literacy domain. RESULTS We identified 131 unique DHIs conducted in 26 different countries between 2001 and 2020. Most DHIs were conducted in English-speaking countries (n=81, 61.8%), delivered via the web (n=68, 51.9%), and addressed issues related to noncommunicable diseases (n=57, 43.5%) or mental health (n=26, 19.8%). None of the interventions assessed all six domains of the eHealth literacy model. Most studies focused on the domain of health literacy (n=96, 73.2%), followed by digital (n=19, 14.5%), basic and media (n=4, 3%), and information and scientific literacy (n=1, 0.7%). Of the 131 studies, 7 (5.3%) studies covered both health and digital literacy. CONCLUSIONS Although many selected DHIs assessed health or digital literacy, no studies comprehensively evaluated all domains of the eHealth literacy model; this evidence might be overlooking important factors that can mediate or moderate the effects of these interventions. Future DHIs should comprehensively assess the eHealth literacy model while developing or evaluating interventions to understand how and why interventions can be effective.
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Affiliation(s)
- Mariam El Benny
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Tamar Kabakian-Khasholian
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Fadi El-Jardali
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Marco Bardus
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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6
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Friis RB, Hjollund NH, Mejdahl CT, Pappot H, Skuladottir H. Electronic symptom monitoring in patients with metastatic lung cancer: a feasibility study. BMJ Open 2020; 10:e035673. [PMID: 32554725 PMCID: PMC7304800 DOI: 10.1136/bmjopen-2019-035673] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To design an electronic questionnaire for symptom monitoring and to evaluate the feasibility, usability and acceptability when applied to patients with metastatic lung cancer. SETTING Single-centre feasibility study. PARTICIPANTS Patients with stage IV lung cancer in antineoplastic treatment. INTERVENTIONS This study describes the first three phases of a complex intervention design: phase 1, development of the intervention; phase 2, feasibility testing and phase 3, evaluation of the intervention. In phase 1, items were selected for the questionnaire and adjusted following patient interviews. In phase 2, patients completed the electronic questionnaire weekly during a 3-week feasibility test. In case of symptom deterioration, a nurse was notified with the aim to contact the patient. In phase 3, patients evaluated phase 2 by paper questionnaires, and interviews were conducted with the participating nurses. PRIMARY OUTCOME MEASURES The study outcomes: phase 1, usability and relevance; phase 2, recruitment rate, compliance and threshold functionality and phase 3, usability, acceptability and relevance. RESULTS In phase 1, a questionnaire was designed and reviewed by patients (n=8). The interviews revealed high usability and relevance of the intervention.For phases 2 and 3, 20 of 29 approached patients (69%) responded to the questionnaire on a weekly basis. Two patients did not complete any questionnaires (compliance 90%). The remaining 18 patients completed 65 of a total of 72 possible questionnaires (7 missed, 93% completed). Reported symptoms led to a phone call from a nurse in 30% of the responses.The patients reported high usability and acceptability of questionnaire and software. The substance of the telephonic conversations was relevant, and the study set-up was logistically acceptable. CONCLUSIONS An electronic questionnaire designed for symptom monitoring revealed high usability, acceptability and relevance in the target population. In conclusion, the study set-up was considered feasible for a randomised controlled trial. TRIAL REGISTRATION NUMBER NCT03529851.
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Affiliation(s)
| | - Niels Henrik Hjollund
- AmbuFlex, Occupational Medicine, University Research Clinic, Aarhus University, Hospital Unit West Jutland, Herning, Denmark
- Department of Clinical Epidemiology, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Caroline Trillingsgaard Mejdahl
- AmbuFlex, Occupational Medicine, University Research Clinic, Aarhus University, Hospital Unit West Jutland, Herning, Denmark
| | - Helle Pappot
- Department of Oncology, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Halla Skuladottir
- Department of Oncology, Hospital Unit West Jutland, Herning, Denmark
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Mejdahl CT, Schougaard LMV, Hjollund NH, Riiskjær E, Lomborg K. Patient-reported outcome measures in the interaction between patient and clinician - a multi-perspective qualitative study. J Patient Rep Outcomes 2020; 4:3. [PMID: 31919602 PMCID: PMC6952477 DOI: 10.1186/s41687-019-0170-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 12/18/2019] [Indexed: 11/10/2022] Open
Abstract
Background This article addresses patient-reported outcome (PRO)-based follow-up used as a substitute for regularly scheduled follow-ups. In PRO-based follow-up, patients’ PRO data filled in by the patients at home are used by clinicians as a decision aid to identify those who need clinical attention based on an automated PRO algorithm, clinical attention being either a phone call or a physical consultation. A physical consultation in the outpatient clinic prompted by the patient’s PRO is termed a “PRO consultation.” In this multi-perspective qualitative study, we explored the influence of patients’ self-reported data on patient-clinician interaction during PRO consultations in epilepsy outpatient clinics. Interpretive description was the methodological approach, applying data from participant observations, informal interviews with clinicians, and semi-structured interviews with clinicians and patients. Results We found that application and deliberate use of patients’ PRO measures can affect patient-clinician interaction, promoting patient involvement in terms of improved communication and increased patient activation. These findings reflect the general patterns that have been reported in the literature. In addition, we found that PRO measures also may induce unmet expectations among some patients that can have a negative effect on patients’ experiences of the interaction and their follow-up experience in general. We extracted two thematic patterns that represent PRO measures’ potential for patient involvement in the patient-clinician interaction. The first pattern represents enablers, and the second pattern represents barriers for PRO measures to affect patient involvement. Conclusions Applying PRO measures in clinical practice does not automatically enhance the patient-clinician interaction. To strengthen the benefits of PRO measures, the following supplementary clinical initiatives are suggested: summarizing and reporting the PRO measures back to the patient, considering carefully which PRO measures to include, training clinicians and assuring that the patients’ introduction to PRO-based follow-up clarifies expectations.
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Affiliation(s)
- Caroline Trillingsgaard Mejdahl
- AmbuFlex/WestChronic, Occupational Medicine, University Research Clinic, Aarhus University, Herning, Gl Landevej 61, DK-7400, Herning, Denmark. .,The Research Centre for Patient Involvement, Aarhus University & the Central Denmark Region, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus, Denmark.
| | - Liv Marit Valen Schougaard
- AmbuFlex/WestChronic, Occupational Medicine, University Research Clinic, Aarhus University, Herning, Gl Landevej 61, DK-7400, Herning, Denmark
| | - Niels Henrik Hjollund
- AmbuFlex/WestChronic, Occupational Medicine, University Research Clinic, Aarhus University, Herning, Gl Landevej 61, DK-7400, Herning, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Olof Palmes Allé 43-45, DK-8200, Aarhus, Denmark
| | - Erik Riiskjær
- DEFACTUM, Social & Health Services and Labour Market, Olof Palmes Allé 15, DK-8200, Aarhus, Central Denmark Region, Denmark
| | - Kirsten Lomborg
- The Research Centre for Patient Involvement, Aarhus University & the Central Denmark Region, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, DK-8200, Aarhus, Denmark
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Zhu Z, Li Y, Meng X, Han J, Li Y, Liu K, Shen J, Qin Y, Zhang H. New warfarin anticoagulation management model after heart valve surgery: rationale and design of a prospective, multicentre, randomised trial to compare an internet-based warfarin anticoagulation management model with the traditional warfarin management model. BMJ Open 2019; 9:e032949. [PMID: 31811010 PMCID: PMC6924837 DOI: 10.1136/bmjopen-2019-032949] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Warfarin is an effective anticoagulant and the only oral anticoagulant available for patients with mechanical heart valves. The prothrombin time and the associated international normalised ratio (INR) are routinely tested to monitor the response to anticoagulation therapy in patients. Patients who undergo mechanical heart valve replacement need lifelong anticoagulation therapy, and their INR is regularly measured to adjust the anticoagulation strength and the dose of anticoagulation drugs. Appropriate warfarin anticoagulation management can reduce patient complications, such as bleeding and thrombosis, and improve the long-term survival rate. We propose modern internet technology as a platform to build a warfarin anticoagulation follow-up system after valve replacement surgery. This system will provide doctors and patients with more standardised and safer follow-up methods as well as a method to further reduce the risk of warfarin anticoagulation-related complications and improve its therapeutic effects. METHODS AND ANALYSIS A prospective, multicentre, randomised, controlled trial will be conducted. A total of 700 patients who require long-term warfarin anticoagulation monitoring after heart valve replacement will be enrolled and randomly divided at a 1:1 ratio into a traditional outpatient anticoagulation management group and a group undergoing a new method of management based on the internet technology with follow-up for 1 year. Differences in the percentage of time in the therapeutic range (TTR), drug dose adjustments, bleeding/thrombosis and other related complications will be observed. The primary endpoint is the difference in the TTR between the two groups. The purpose of this study is to explore a safer and more effective mode of doctor-patient interaction and communication in the internet era. As of 13 July 2019, 534 patients had been enrolled. ETHICS AND DISSEMINATION This study protocol was approved by the Ethics Committee of Beijing Anzhen Hospital, Capital Medical University. The results will be published in a peer-reviewed medical journal. TRIAL REGISTRATION NUMBER ChiCTR1800016204.
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Affiliation(s)
- Zhihui Zhu
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yuehuan Li
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xu Meng
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jie Han
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yan Li
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Kun Liu
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jinglun Shen
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ying Qin
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Haibo Zhang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Hjollund NHI. Fifteen Years' Use of Patient-Reported Outcome Measures at the Group and Patient Levels: Trend Analysis. J Med Internet Res 2019; 21:e15856. [PMID: 31573943 PMCID: PMC6792031 DOI: 10.2196/15856] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 09/09/2019] [Accepted: 09/20/2019] [Indexed: 02/06/2023] Open
Abstract
Background Since 2004, we have collected patient-reported outcome (PRO) data from several Danish patient populations for use at the group and patient levels. Objective The aim of this paper is to highlight trends during the last 15 years with respect to patient inclusion, the methods for collection of PRO data, the processing of the data, and the actual applications and use of the PRO measurements. Methods All PRO data have been collected using the AmbuFlex/WestChronic PRO system, which was developed by the author in 2004 and has been continuously updated since. The analysis of trends was based on a generic model applicable for any kind of clinical health data, according to which any application of clinical data may be divided into four processes: patient identification, data collection, data aggregation, and the actual data use. Data for analysis were generated by a specific application in the system and transferred for analysis to the R package. Results During the 15-year period, 78,980 patients within 28 different groups of chronic and malignant illnesses have answered 260,433 questionnaires containing a total of 13,538,760 responses. Several marked changes have taken place: (1) the creation of cohorts for clinical epidemiological research purposes has shifted towards cohorts defined by clinical use of PRO data at the patient level; (2) the development of AmbuFlex, where PRO data are used as the entire basis for outpatient follow-up instead of fixed appointments, has undergone exponential growth and the system is currently in use in 47 International Statistical Classification of Diseases and Related Health Problems groups, covering 16,000 patients and 94 departments throughout Denmark; (3) response rates (up to 92%) and low attrition rates have been reached in group level projects, and there are even higher response rates in AmbuFlex where the patients are individually referred; (4) The answering method has shifted, as while in 2005 a total of 66.5% of questionnaires were paper based, this is the case for only 4.3% in 2019; and (5) the approach methods for questionnaires and reminders have changed dramatically from letter, emails, and short message service text messaging to a national, secure electronic mail system through which 93.2% of the communication to patients took place in 2019. The combination of secure email and web-based answering has resulted in a low turnaround time in which half of responses are now received within 5 days. Conclusions The demand for clinical use of PRO measurements has increased, driven by a wish among patients as well as clinicians to use PRO to promote better symptom assessment, more patient-centered care, and more efficient use of resources. Important technological changes have occurred, creating new opportunities, and making PRO collection and use cheaper and more feasible. Several legal changes may constitute a barrier for further development as well as a barrier for better utilization of patients’ questionnaire data. The current legal restrictions on the joint use of health data imposed by the European Union’s General Data Protection Regulation makes no distinction between use and misuse, and steps should be taken to alleviate these restrictions on the joint use of PRO data.
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Affiliation(s)
- Niels Henrik I Hjollund
- AmbuFlex/WestChronic, Occupational Medicine, University Research Clinic, Aarhus University, Herning, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Schougaard LMV, Mejdahl CT, Christensen J, Lomborg K, Maindal HT, de Thurah A, Hjollund NH. Patient-initiated versus fixed-interval patient-reported outcome-based follow-up in outpatients with epilepsy: a pragmatic randomized controlled trial. J Patient Rep Outcomes 2019; 3:61. [PMID: 31520247 PMCID: PMC6744536 DOI: 10.1186/s41687-019-0151-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 08/27/2019] [Indexed: 12/14/2022] Open
Abstract
Background The use of patient-reported outcome (PRO) could potentially contribute to the reorganization of the health care system. AmbuFlex is a PRO system used in remote patient monitoring, in which questionnaires are sent to patients at fixed intervals. The PRO data are used by clinicians to decide whether patients need clinical attention. Better self-management and cost-saving follow-up activities may be achieved by letting patients initiate need of contact. We evaluated the effects of patient-initiated PRO-based outpatient follow-up on health care resource utilization, quality of care, and the patient perspective. Methods We conducted a parallel two-arm pragmatic randomized controlled trial at the Department of Neurology, Aarhus University Hospital, Denmark. Outpatients with epilepsy (≥ 15 years old), attending fixed-interval PRO-based follow-up with web-based questionnaires, were randomly assigned in a ratio of 0.55:0.45 to either 1) patient-initiated PRO-based follow-up (open access telePRO) or 2) fixed-interval PRO-based follow-up (standard telePRO). The primary outcome was the number of outpatient hospital contacts related to epilepsy retrieved from a regional registry. Hospitals admissions and emergency room visits were also assessed. Secondary self-reported outcomes including general health, well-being, health literacy, self-efficacy, number of seizures, side effects, confidence, safety, and satisfaction were retrieved from questionnaires. Data were analyzed by the intention-to-treat and per-protocol approaches. Results Between January 2016 and July 2016, 593 patients were randomized to either open access telePRO (n = 346) or standard telePRO (n = 247). At 18 months, no statistically significant differences were found between the arms regarding number of telephone consultations or outpatient visits. Patients in the open access arm had a slightly lower, statistically significant number of emergency room visits than patients in the standard arm. Self-reported mental well-being in the open access arm was slightly, statistically significantly lower than in the standard arm. Other secondary outcomes did not differ statistically significantly between arms. Conclusion This study did not find, as hypothesized, less use of health care resources or improved patient self-management or satisfaction in the patient-initiated PRO-based initiative compared to fixed-interval PRO-based follow-up. Patient-initiated PRO-based follow-up may be used as an alternative to fixed-interval PRO-based follow-up in patients who prefer this approach, but there is insufficient evidence for recommending a system-wide shift to patient-initiated PRO-based follow-up. Trial registration Registered 4 February 2016 with ClinicalTrials.gov: NCT02673580. Electronic supplementary material The online version of this article (10.1186/s41687-019-0151-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Liv Marit Valen Schougaard
- AmbuFlex/WestChronic, Occupational Medicine, University Research Clinic, Aarhus University, Gl. Landevej 61, DK-7400, Herning, Denmark.
| | - Caroline Trillingsgaard Mejdahl
- AmbuFlex/WestChronic, Occupational Medicine, University Research Clinic, Aarhus University, Gl. Landevej 61, DK-7400, Herning, Denmark
| | - Jakob Christensen
- Department of Neurology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, DK-8200, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, DK-8200, Aarhus N, Denmark
| | - Kirsten Lomborg
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, DK-8200, Aarhus N, Denmark
| | | | - Annette de Thurah
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, DK-8200, Aarhus N, Denmark.,Department of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 59, DK-8200, Aarhus N, Denmark
| | - Niels Henrik Hjollund
- AmbuFlex/WestChronic, Occupational Medicine, University Research Clinic, Aarhus University, Gl. Landevej 61, DK-7400, Herning, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200, Aarhus N, Denmark
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11
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Grove BE, Ivarsen P, de Thurah A, Schougaard LM, Kyte D, Hjøllund NH. Remote follow-up using patient-reported outcome measures in patients with chronic kidney disease: the PROKID study - study protocol for a non-inferiority pragmatic randomised controlled trial. BMC Health Serv Res 2019; 19:631. [PMID: 31484523 PMCID: PMC6727325 DOI: 10.1186/s12913-019-4461-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 08/26/2019] [Indexed: 12/14/2022] Open
Abstract
Background Outpatient care is steadily changing from hospital consultations to other platforms, such as phone consultation and online virtual clinics. It is prudent to maintain quality of care with such initiatives. Currently, patients with chronic kidney disease (CKD) have frequent scheduled visits, but it may be possible to optimise the frequency of hospital consultations using information from patient-reported outcome (PRO) questionnaires filled in at home (PRO-based follow-up). This approach may provide a more individually tailored follow-up based on actual needs for clinical attention. We aimed to evaluate the effectiveness of the quality of care, use of resources and patient outcomes associated with PRO-based follow-up in patients with CKD. Methods This study is a pragmatic, non-inferiority, randomised controlled trial in outpatients with CKD (Grove BE et al., Qual Life Res 27: S143, 2018). Newly referred patients with an estimated glomerular filtration rate (eGFR) of ≤40 ml/min 1.73m2 will be randomised to either:
PRO-based remote follow-up PRO-based telephone consultation Usual outpatient follow-up (control group)
In the two intervention groups, a diagnosis-specific PRO questionnaire completed by the patient at home will substitute for usual outpatient follow-up visits. The PRO questionnaire will in part be used as a screening tool to identify patients in need of outpatient contact and to identify focus areas. Responses from the questionnaire will be processed according to a disease-specific algorithm and assigned green, yellow or red status according to patients’ needs. The primary outcome will be loss of renal function evaluated by eGFR. Secondary outcomes are 1. Clinical outcomes, including initiation of acute dialyses, hospitalisation and mortality, 2. Utilisation of healthcare resources and 3. PRO measures, primarily quality of life (Euroqol EQ-5D) and illness perception (Brief Illness Perception Questionnaire (BIPQ). Discussion Benefits and possible drawbacks of the PRO-based follow-up will be evaluated. If PRO-based follow-up proves non-inferior to usual outpatient follow-up, a reorganisation of routine clinical practice in nephrology outpatient clinics may occur. Further, results may impact other patient groups with chronic conditions attending regular follow-up. Trial registration ClinicalTrials.gov identifier NCT03847766 (Retrospectively registered on January 23, 2019).
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Affiliation(s)
- Birgith Engelst Grove
- AmbuFlex/WestChronic, Occupational Medicine, University Research Clinic, Aarhus University, Herning, Denmark.
| | - Per Ivarsen
- Department of Nephrology, Aarhus University Hospital, Aarhus, Denmark
| | - Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Liv Marit Schougaard
- AmbuFlex/WestChronic, Occupational Medicine, University Research Clinic, Aarhus University, Herning, Denmark
| | - Derek Kyte
- Health Research Methods, Centre for Patient-Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Niels Henrik Hjøllund
- AmbuFlex/WestChronic, Occupational Medicine, University Research Clinic, Aarhus University, Herning, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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12
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Leviton A, Oppenheimer J, Chiujdea M, Antonetty A, Ojo OW, Garcia S, Weas S, Fleegler E, Chan E, Loddenkemper T. Characteristics of Future Models of Integrated Outpatient Care. Healthcare (Basel) 2019; 7:healthcare7020065. [PMID: 31035586 PMCID: PMC6627383 DOI: 10.3390/healthcare7020065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 01/01/2023] Open
Abstract
Replacement of fee-for-service with capitation arrangements, forces physicians and institutions to minimize health care costs, while maintaining high-quality care. In this report we described how patients and their families (or caregivers) can work with members of the medical care team to achieve these twin goals of maintaining-and perhaps improving-high-quality care and minimizing costs. We described how increased self-management enables patients and their families/caregivers to provide electronic patient-reported outcomes (i.e., symptoms, events) (ePROs), as frequently as the patient or the medical care team consider appropriate. These capabilities also allow ongoing assessments of physiological measurements/phenomena (mHealth). Remote surveillance of these communications allows longer intervals between (fewer) patient visits to the medical-care team, when this is appropriate, or earlier interventions, when it is appropriate. Systems are now available that alert medical care providers to situations when interventions might be needed.
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Affiliation(s)
- Alan Leviton
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Julia Oppenheimer
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Madeline Chiujdea
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Annalee Antonetty
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Oluwafemi William Ojo
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Stephanie Garcia
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Sarah Weas
- Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Eric Fleegler
- Division of Emergency Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Eugenia Chan
- Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Tobias Loddenkemper
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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13
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Zhu Z, Zhang H, Li Y, Meng X, Jiao Y, Qin Y, Li Y, Han J, Liu K, Liu C. Establishment of a New Platform for the Management of Patients After Cardiac Surgery: Descriptive Study. JMIR Med Inform 2019; 7:e13123. [PMID: 30932865 PMCID: PMC6462895 DOI: 10.2196/13123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 01/25/2019] [Accepted: 01/27/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Medical care for the Chinese population has been focused on first-line treatment, but with little follow-up on treated patients. As an important part of clinical work, follow-up evaluations are of great significance for the long-term survival of patients and for clinical and scientific research. However, the overall follow-up rate of discharged patients after surgery has been low for many years because of the limitations of certain follow-up methods and the presence of objective, practical problems. OBJECTIVE This study aimed to construct a new two-way interactive telemedicine follow-up platform to improve the collection of clinical data after cardiac surgery and provide reliable and high-quality follow-up services. METHODS Computer and network technologies were employed in the context of "Internet +" to develop follow-up databases and software compatible with a mobile network. Postoperative follow-up quality data including the follow-up rate and important postoperative indices were used as standards to evaluate the new follow-up management model after cardiac surgery. RESULTS This system has been officially operated for more than 5 years. A total of 5347 patients undergoing cardiac surgery have been enrolled, and the total follow-up rate was 90.22%. In addition, 6349 echocardiographic images, 4717 electrocardiographic images, and 3504 chest radiographic images have been uploaded during follow-up assessments. The international standardized ratio was 20,696 person-times. CONCLUSIONS This new management follow-up platform can be used to effectively collect clinical data, provide technical support for academic research, extend medical services, and provide more help to patients. It is of great significance for managing patients after cardiac surgery.
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Affiliation(s)
- Zhihui Zhu
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Haibo Zhang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yuehuan Li
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xu Meng
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yuqing Jiao
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ying Qin
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yan Li
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jie Han
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Kun Liu
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chongyang Liu
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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14
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Bech LK, Borch Jacobsen C, Mathiesen AS, Thomsen T. Preferring to manage by myself: A qualitative study of the perspectives of hardly reached people with type 2 diabetes on social support for diabetes management. J Clin Nurs 2019; 28:1889-1898. [PMID: 30667563 DOI: 10.1111/jocn.14783] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 11/19/2018] [Accepted: 11/30/2018] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore the perspectives of hardly reached people with type 2 diabetes on social support for diabetes management from their formal and informal networks. BACKGROUND People with low socioeconomic status and poorly controlled type 2 diabetes may be categorised as hardly reached. Social support is increasingly perceived to be a cornerstone in the management of type 2 diabetes. Few studies have, however, explored social support for diabetes management from the perspective of hardly reached people. METHODS A qualitative design with individual semi-structured interviews captured the unique perspectives of hardly reached people. Data from 14 participants were analysed using conventional content analysis. The article adheres to the COREQ guidelines for reporting qualitative research. RESULTS Participants preferred not to involve family and friends (the informal network) in diabetes management due to dysfunctional or lacking networks, existing norms and not wanting to burden vulnerable relationships. Others simply did not perceive themselves as sick and therefore saw no need for support. Opposed to this, participants wished for continuity and a personalised relationship with health professionals (the formal network). This entailed consultations that facilitated discussion of issues of importance to the participants. CONCLUSIONS Hardly reached people with type 2 diabetes preferred to spare their informal networks from diabetes management. Instead, they wished for more presence and individualised support from health professionals. RELEVANCE TO CLINICAL PRACTICE It appears timely to rethink the current "one-size-fits-all" approach for people with type 2 diabetes in order to allocate resources to those most in need. It is important that health professionals elicit perceptions of support needs and potential sources of support in hardly reached people with type 2 diabetes both from the formal and from informal networks in regard to managing their diabetes. To better reach hardly reached people with type 2 diabetes, specialised education of health professionals may be necessary to capture the complex underlying dynamics influencing disease management.
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Affiliation(s)
- Laura K Bech
- Abdominal Centre, University Hospital of Copenhagen Rigshospitalet, Copenhagen, Denmark.,Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Camilla Borch Jacobsen
- Abdominal Centre, University Hospital of Copenhagen Rigshospitalet, Copenhagen, Denmark.,Department of Haematology, Finsen Centre, University Hospital of Copenhagen Rigshospitalet, Copenhagen, Denmark
| | - Anne Sophie Mathiesen
- Abdominal Centre, University Hospital of Copenhagen Rigshospitalet, Copenhagen, Denmark.,Department of Endocrinology, Abdominal Centre, University Hospital of Copenhagen Rigshospitalet, Copenhagen, Denmark
| | - Thordis Thomsen
- Abdominal Centre, University Hospital of Copenhagen Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Science, Faculty of Health Science, University Hospital of Copenhagen, Copenhagen, Denmark
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15
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Mejdahl CT, Schougaard LMV, Hjollund NH, Riiskjær E, Thorne S, Lomborg K. PRO-based follow-up as a means of self-management support - an interpretive description of the patient perspective. J Patient Rep Outcomes 2018; 2:38. [PMID: 30238083 PMCID: PMC6125260 DOI: 10.1186/s41687-018-0067-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 08/20/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND There is an increasing focus on the use of patient-reported outcome (PRO) measures to improve the quality and effectiveness of health care. PRO-based follow-up is a new model of service delivery, where the patient's PRO measures are used as the very basis for outpatient follow-up. OBJECTIVES This study aimed to explore how patients with epilepsy experience the use of PRO-based follow-up in three outpatient clinics in the Central Denmark Region. We also sought to explain how these experiences relate to self-management. METHODS Interpretive description was the methodological approach. We conducted in-depth individual interviews with 29 patients referred to PRO-based follow-up, each of whom had completed at least two PRO questionnaires. Participants were sampled based on purposive and theoretical sampling. RESULTS PRO-based follow-up may support patients' self-management by a) increasing awareness of psychosocial problems, b) improving communication, c) increasing understanding of symptoms, d) facilitating change in health behavior and e) strengthening autonomy. Inhibitors for PRO measures as a means of self-management support were identified as a) feelings of rejection and disconnection, b) incomprehension of purpose of PRO-based follow-up, c) PRO measures being too standardized and negative and d) lack of confidence in own ability to assess PRO questionnaires. CONCLUSION The findings demonstrate broad variation in the influences of PRO measures on patient's self-management in life with epilepsy. Sense of ownership may explain this variation. We suggest supplementary clinical initiatives in order to enhance the benefits from PRO-based follow-up, particularly on how patients are allocated to this health care service.
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Affiliation(s)
- Caroline Trillingsgaard Mejdahl
- Department of Public Health, Aarhus University, Bartholins Allé 2, DK-8000 Aarhus, Denmark
- The Research Program in Patient Involvement, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus, Denmark
| | - Liv Marit Valen Schougaard
- WestChronic, Occupational Medicine, University Research Clinic, Aarhus University, Herning, Gl Landevej 61, DK-7400 Herning, Denmark
| | - Niels Henrik Hjollund
- WestChronic, Occupational Medicine, University Research Clinic, Aarhus University, Herning, Gl Landevej 61, DK-7400 Herning, Denmark
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45. DK-8200 Aarhus N, Aarhus, Denmark
| | - Erik Riiskjær
- DEFACTUM, Social & Health Services and Labour Market, Central Denmark Region, Olof Palmes Allé 15, DK-8200 Aarhus, Denmark
| | - Sally Thorne
- University of British Columbia School of Nursing, 2211 Wesbrook Mall, Vancouver, BC V6T 2B5 Canada
| | - Kirsten Lomborg
- The Research Program in Patient Involvement, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, DK-8200 Aarhus, Denmark
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16
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Mejdahl CT, Schougaard LMV, Hjollund NH, Riiskjær E, Lomborg K. Exploring organisational mechanisms in PRO-based follow-up in routine outpatient care - an interpretive description of the clinician perspective. BMC Health Serv Res 2018; 18:546. [PMID: 30001729 PMCID: PMC6044066 DOI: 10.1186/s12913-018-3352-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 07/03/2018] [Indexed: 11/12/2022] Open
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. Electronic supplementary material The online version of this article (10.1186/s12913-018-3352-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Caroline Trillingsgaard Mejdahl
- Department of Public Health, Aarhus University, Bartholins Allé 2, DK-8000, Aarhus, C, Denmark. .,The Research Program in Patient Involvement, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus, N, Denmark.
| | - Liv Marit Valen Schougaard
- WestChronic, Occupational Medicine, University Research Clinic, Aarhus University, Herning Gl Landevej 61, DK-7400, Herning, Denmark
| | - Niels Henrik Hjollund
- WestChronic, Occupational Medicine, University Research Clinic, Aarhus University, Herning Gl Landevej 61, DK-7400, Herning, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Olof Palmes Allé 43-45, DK-8200, Aarhus, N, Denmark
| | - Erik Riiskjær
- DEFACTUM, Social & Health Services and Labour Market, Central Denmark Region, Olof Palmes Allé 15, DK-8200, Aarhus, N, Denmark
| | - Kirsten Lomborg
- The Research Program in Patient Involvement, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus, N, Denmark.,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, DK-8200, Aarhus, N, Denmark
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