Patient-reported outcome measures for medication-related quality of life: A scoping review

BACKGROUND

Medication use is common for the prevention and treatment of many health conditions. Understanding the impact of medication-taking on quality of life is important, as it could contribute to better care plans and improve shared decision-making between patients and healthcare providers.

OBJECTIVE

To systematically identify and summarize the extent of literature on patient-reported outcome measures (PROMs) for medication-related quality of life (QoL).

METHODS

Medline, Embase, PsycINFO, and Health and Psychosocial Instruments databases were searched until May 17, 2021 for peer-reviewed, original research articles that included a PROM for medication-related QoL and reported its psychometric properties. Study selection were completed by pairs with a third reviewer resolving any conflicts. Data were extracted by the study team using a form in Microsoft Excel. Extracted data were summarized descriptively and tabulated numerically.

RESULTS

We screened 8,878 records, including 170 full-text articles, of which 86 met the criteria for inclusion. We identified 80 unique PROMs. Over half (n = 53) described measuring treatment satisfaction and less than one quarter measured medication related-QoL more broadly. Most of the included PROMs were targeted towards populations with specific health conditions including cancer (n = 9) and diabetes (n = 8), as well as individuals taking medication for non-specific conditions (n = 7). The most reported psychometric properties were internal consistency (n = 75) and construct validity (n = 77). All PROMs but one (n = 79) assessed physical health but fewer assessed other QoL dimensions (e.g., autonomy, interactions with providers).

CONCLUSIONS

We found that the PROMs were designed for condition-specific or medication-specific populations, with few for general medication-related QoL. Future research should focus on assessing medication-related QoL measures for broader populations such as those with disabilities, multimorbidity, or experiencing polypharmacy. There needs to be more guidance on how to implement the use of PROMs in clinical settings, as well as to ensure consistency around terminology related to QoL.

Clinical management of patients with hip and knee osteoarthritis: patient satisfaction with treatment switch

Hip and knee osteoarthritis (OA) is a common cause of disability, with great quality of life and economic impact, hence the need for effective treatment. Patient satisfaction with treatment is a measure of therapeutic effectiveness and may be used to assess treatment switch in OA patients. A 3-month multicenter, prospective, epidemiologic, non-interventional study was conducted in patients with hip and/or knee OA to assess therapeutic efficacy in patients requiring treatment switch due to lack of effectiveness and/or tolerability in primary care settings. Therapeutic effectiveness was assessed by patient satisfaction using the osteoARthritis Treatment Satisfaction (ARTS) scale. The 3-month disease change [by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and a pain visual analog scale (VAS)] and its correlation with treatment satisfaction were also assessed, as well as patient gastrointestinal (GI) and cardiovascular (CV) profiles. 5,976 patients were analyzed (mean age 68.8 years, 65.1 % female). 67 and 61.8 % showed high GI and CV risk, respectively. The proportion of patients on acetaminophen treatment during the study decreased from 74.8 % at baseline to 23.9 %, while the proportion on non-steroidal anti-inflammatory drugs (NSAIDs) increased from 59.8 to 85.8 %. At 3 months, the standardized (0-100) overall ARTS score increased from 57.7 to 71.6 (p < 0.0001), while disease severity decreased. There was a significant (p < 0.0001) negative association between the ARTS, and the WOMAC and VAS scores. Treatment switching from acetaminophen to NSAIDs as a consequence of poor effectiveness and/or tolerability resulted in increased patient satisfaction with treatment and lower OA severity.

Treatment satisfaction after switching to another therapy in Spanish orthopaedic clinic outpatients with knee or hip osteoarthritis previously refractory to paracetamol

BACKGROUND AND OBJECTIVE

Hip and knee osteoarthritis is highly prevalent in the elderly, and the incidence is estimated to increase in the coming decades. Prior to surgery, symptomatic treatment, starting with non-pharmacological therapies, should be prescribed. Paracetamol (acetaminophen) is the recommended first pharmacological treatment for osteoarthritis. If paracetamol is ineffective, non-steroidal anti-inflammatory drug (NSAID) treatment is indicated. The superiority of NSAIDs over paracetamol has been demonstrated in several studies. Furthermore, the assessment of patient satisfaction could be an adequate indicator of the quality of care given and is likely related to the evolution of the condition and the therapeutic regimen. The objective of this study was to assess the satisfaction of patients diagnosed with hip and/or knee osteoarthritis who had been previously treated with paracetamol and switched to NSAID treatment due to a lack of effectiveness by paracetamol.

METHODS

An observational, prospective, multicentre and comparative study was conducted in 2009 among patients diagnosed with hip and knee OA who visited outpatient orthopaedic clinics. The evaluation of treatment effectiveness was carried out using a patient-based visual analogue scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The satisfaction regarding change of treatment due to a lack of effectiveness and/or the presence of adverse effects was evaluated using the osteoARthritis Treatment Satisfaction (ARTS) questionnaire.

RESULTS

A total of 2437 patients were evaluated (knee OA: 1438 [59%]; hip OA: 621 [25.5%]; knee and hip OA: 124 [5.1%]; and without OA location registered: 254 [10.4%]). The study findings showed an increase in patient satisfaction after abandoning the use of paracetamol to treat OA. Statistically significant increases in both overall satisfaction mean (from 57.7 [SD 13.5] to 71.3 [SD 12.0]) and in each of the four domains of the ARTS questionnaire were observed (p < 0.0001 in all cases). According to the WOMAC and a VAS, treatment effectiveness increased significantly after 3 months (p < 0.0001) and significant correlations with satisfaction were observed (r = -0.32 and r = -0.29, respectively; p < 0.0001). The mean (SD) change in global satisfaction in patients treated with NSAIDs was 14.9 (15.5) versus 7.2 (14.4) for patients treated with non-NSAIDs (p < 0.0001). Patients taking NSAID treatment showed substantially more improvement over those taking non-NSAID treatment.

CONCLUSION

NSAIDs relieve pain due to OA in paracetamol-resistant patients and improve treatment effectiveness and patient satisfaction with treatment. Furthermore, paracetamol-refractory subjects under conventional medical treatment with NSAIDs experienced the drug as more effective and also tended to be more satisfied with treatment than those treated with non-NSAIDs.

Treatment satisfaction after switching to another therapy in Spanish orthopaedic clinic outpatients with knee or hip osteoarthritis previously refractory to paracetamol

BACKGROUND AND OBJECTIVE

Hip and knee osteoarthritis is highly prevalent in the elderly, and the incidence is estimated to increase in the coming decades. Prior to surgery, symptomatic treatment, starting with non-pharmacological therapies, should be prescribed. Paracetamol (acetaminophen) is the recommended first pharmacological treatment for osteoarthritis. If paracetamol is ineffective, non-steroidal anti-inflammatory drug (NSAID) treatment is indicated. The superiority of NSAIDs over paracetamol has been demonstrated in several studies. Furthermore, the assessment of patient satisfaction could be an adequate indicator of the quality of care given and is likely related to the evolution of the condition and the therapeutic regimen. The objective of this study was to assess the satisfaction of patients diagnosed with hip and/or knee osteoarthritis who had been previously treated with paracetamol and switched to NSAID treatment due to a lack of effectiveness by paracetamol.

METHODS

An observational, prospective, multicentre and comparative study was conducted in 2009 among patients diagnosed with hip and knee OA who visited outpatient orthopaedic clinics. The evaluation of treatment effectiveness was carried out using a patient-based visual analogue scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The satisfaction regarding change of treatment due to a lack of effectiveness and/or the presence of adverse effects was evaluated using the osteoARthritis Treatment Satisfaction (ARTS) questionnaire.

RESULTS

A total of 2437 patients were evaluated (knee OA: 1438 [59%]; hip OA: 621 [25.5%]; knee and hip OA: 124 [5.1%]; and without OA location registered: 254 [10.4%]). The study findings showed an increase in patient satisfaction after abandoning the use of paracetamol to treat OA. Statistically significant increases in both overall satisfaction mean (from 57.7 [SD 13.5] to 71.3 [SD 12.0]) and in each of the four domains of the ARTS questionnaire were observed (p < 0.0001 in all cases). According to the WOMAC and a VAS, treatment effectiveness increased significantly after 3 months (p < 0.0001) and significant correlations with satisfaction were observed (r = -0.32 and r = -0.29, respectively; p < 0.0001). The mean (SD) change in global satisfaction in patients treated with NSAIDs was 14.9 (15.5) versus 7.2 (14.4) for patients treated with non-NSAIDs (p < 0.0001). Patients taking NSAID treatment showed substantially more improvement over those taking non-NSAID treatment.

CONCLUSION

NSAIDs relieve pain due to OA in paracetamol-resistant patients and improve treatment effectiveness and patient satisfaction with treatment. Furthermore, paracetamol-refractory subjects under conventional medical treatment with NSAIDs experienced the drug as more effective and also tended to be more satisfied with treatment than those treated with non-NSAIDs.

Treatment satisfaction instruments for different purposes during a product's lifecycle: keeping the end in mind

This review investigates whether the development and implementation of treatment satisfaction instruments during a product's lifecycle are informed by their purpose. A basic literature review was performed between 2000 and 2010 using electronic databases (PubMed, PsycINFO®, and EMBASE) and the keywords 'satisfaction' and 'questionnaire' and 'medication' or 'drug'. Relevant articles were reviewed to extract the following information: type of study; study objectives; treatment satisfaction instrument used; clinical condition/indication; purpose of instrument; development of instrument; association of satisfaction with other endpoint measures; and main results and conclusions. Of 875 abstracts, 80 articles were further considered. Treatment satisfaction instruments were most commonly used in observational studies and interventional clinical trials. The review indicated similarities regarding the development and validation of satisfaction instruments, such as using patient input to derive the items and exploring classical measurement properties specific to the target population. Although some differences were apparent between instruments intended for use in clinical trials and clinical practice (e.g. the approaches used to enable the interpretation of satisfaction scores), the specificities of the implementation of treatment satisfaction during a product's lifecycle were rarely considered. By 'keeping the end in mind', data from treatment satisfaction instruments can help at three key stages: (i) product access to market: generating evidence as part of an overall value proposition to facilitate product reimbursement at a national level; (ii) market access to product: making the product available at a local level (e.g. local hospital formularies); and (iii) clinical practice: enhancing market penetration and product expansion after launch, and demonstrating value for prescribers. Furthermore, the development, validation, and interpretation of scores from treatment satisfaction instruments should be sensitive to the intended purpose. By considering the stage in the product lifecycle when an instrument is to be used, treatment satisfaction instruments can be developed with the specific research purpose and target audience in mind - whether it be patients, payers, or prescribers. In the future, treatment satisfaction instruments will become increasingly important for informing decisions at the individual level, giving patients a voice towards their overall management and care, and enhancing the relationship between doctor and patient.