scholarly journals Clinical Outcomes of a Primary Care Liaison Psychiatry Service for Patients with Complex Persistent Physical Symptoms.

2022 ◽  
Author(s):  
Chris Schofield ◽  
Lori Edwards Suarez ◽  
Nathan Schofield
Keyword(s):  
Primary Care ◽  
Medically Unexplained Symptoms ◽  
Healthcare Setting ◽  
Patient Reported Outcome Measures ◽  
Service Evaluation ◽  
Physical Symptoms ◽  
Patient Reported Outcome ◽  
Liaison Psychiatry ◽  
Co Morbidity ◽  
Patient Reported

Abstract Background: Patients with Persistent Physical Symptoms (PPS) may have chronic physical disorders such as diabetes, COPD, Crohn’s, MS and/or ongoing medically unexplained symptoms, and in either case there can be both physical and [psychiatric aetiologies combined. Such co-morbidity tends to be chronic and hard to manage in any healthcare setting and therefore frequent attendance in healthcare settings is present for these patients. We rolled out a primary care based integrated multidisciplinary liaison psychiatry team to 3 CCG areas in Nottinghamshire in October 2019 to see this patient group and have taken patient reported outcome measures from baseline up to 15 months later as part of normal service evaluation. Results: We show here that there are clinically relevant and statistically significant improvements in depressive symptoms (PHQ-9), anxiety symptoms (GAD-7) and physical symptoms (PHQ-15). The improvements in the EQ-5D-5L shows that in a whole health measure there are significant improvements over all and specifically in the anxiety/depression and usual activity domains. Conclusion: This is clinically very relevant especially when seen in the context that these results were achieved despite a pandemic affecting the whole population. This model is scalable and integrated providers should look to implement it.

A tale of 2,000 charts: Measuring provider response to patient-reported outcome measures.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 157-157
Author(s):  
Gillian Hurwitz ◽  
Zahra Ismail ◽  
Lesley Moody ◽  
Lisa Catherine Barbera
Keyword(s):  
Outcome Measures ◽  
Patient Reported Outcome Measures ◽  
Physical Symptoms ◽  
Patient Reported Outcome ◽  
Assessment System ◽  
Screening Methods ◽  
Depression And Anxiety ◽  
Chart Audit ◽  
Symptom Screening ◽  
Patient Reported

157 Background: Patients undergoing cancer treatment often experience physical and psychosocial symptoms that go undetected by clinicians, which highlights the need to incorporate patient-reported outcome measures (PROMs) in routine care. Systematic symptom screening for cancer patients using the Edmonton Symptom Assessment System (ESAS) is standard practice in Ontario. However, provider response to PROMs is essential to addressing symptom burden. To measure provider response, Regional Cancer Centre (RCC) Leads and Cancer Care Ontario developed a chart audit process. The objective was to determine whether the clinical team acknowledged, assessed and/or addressed symptoms identified by ESAS screening. Methods: RCCs received a chart audit tool with preset options and a data dictionary. Sites audited at least 140 charts for seven of the ESAS symptoms. Sites used a business intelligence tool to access patient charts based on sampling parameters. RCCs were required to audit charts of patients whose ESAS symptom scores were moderate to severe (4-10), with at least five charts in the moderate range (4-6). Results: 2,380 charts from 13 RCCs were audited based on ESAS scores from September to December 2016. Symptoms were most often acknowledged when the intensity was severe (69.9%), regardless of symptom type. Acknowledgement (71.5%), assessment (67.7%) and intervention (55.8%) were most often offered to patients reporting pain. Patients reporting depression and anxiety were the least likely to have the symptom acknowledged (44.5%, 45.0%, respectively) and be offered assessments (45.8%, 50.1%, respectively) and interventions (35.7%, 36.6%, respectively). Patients reporting moderate to severe depression and anxiety most commonly declined interventions (7.8%, 7.7%, respectively). Conclusions: These data show that providers disproportionately respond to physical symptoms, which may be easiest to treat due to clear management plans and referral pathways. To truly offer person-centred care, the emotional burden related to cancer must also be addressed, and providers must be trained to properly respond to psychosocial symptoms. Chart audits identify gaps in symptom management and areas for quality improvement.

scholarly journals The Patient-Reported Outcome Measures Used with Low Back Pain and the Attitude of Primary Healthcare Practitioners in Saudi Arabia toward Them

Medicina ◽  
2021 ◽  
Vol 57 (8) ◽  
pp. 812
Author(s):  
Ahmed Alhowimel ◽  
Faris Alodaibi ◽  
Mazyad Alotaibi ◽  
Dalyah Alamam ◽  
Julie Fritz
Keyword(s):  
Primary Care ◽  
Saudi Arabia ◽  
Outcome Measures ◽  
Primary Care Physicians ◽  
Physical Therapists ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Low Back ◽  
Knowledge And Beliefs ◽  
Patient Reported

Background and objectives: The use of appropriate outcome measures can help guide multidimensional low back pain (LBP) management, elucidate the efficacy/effectiveness of interventions, and inform clinicians when selected targets have been achieved and this can be used for educational or research purposes. Aim: This study aimed to explore and describe the use, attitudes, knowledge, and beliefs regarding patient-reported outcome measures used by healthcare practitioners practising in Saudi Arabia who are frequently involved in the healthcare of individuals with LBP. Materials and Methods: A cross-sectional design was undertaken using a web-based survey. An electronic invitation to participate was sent to primary care physicians and physical therapists practising in Saudi Arabia. The survey included three sections: demographic data, a list of the most commonly used patient-reported outcome measures with LBP patients, and statements regarding attitudes, knowledge, and beliefs about outcome measures. Results: A total of 156 practitioners participated: 45 primary care physicians and 111 physical therapists. The numeric pain rating and visual analogue scales were the outcome measures most frequently reported as being often used by both primary care physicians and physical therapists. The majority of participants reported often using 1–2 patient reported outcome measures (PROMs). While most participants indicated that they were confident at selecting the most appropriate PROM, fewer were familiar with the concept of the minimally important clinical difference. A lack of Arabic versions of PROMs was reported as a barrier to using them to assess pain. Conclusions: This study shows that, although primary care physicians and physical therapists in Saudi Arabia frequently use patient-reported outcome measures in their clinical management of patients with LBP, there is a noticeable gap in the knowledge and use of the multidimensional outcome measures for LBP management among the participants. This highlights a need for professional training on the use of standardised outcome measures related to LBP.

scholarly journals The use of patient-reported outcome measures in primary care: applications, benefits and challenges

2021 ◽  
Vol 5 (S2) ◽  
Author(s):  
Krista Brower ◽  
Margo Schmitt-Boshnick ◽  
Michel Haener ◽  
Shea Wilks ◽  
Allison Soprovich
Keyword(s):  
Primary Care ◽  
Outcome Measurement ◽  
Local Population ◽  
Target Population ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Full Potential ◽  
System Quality ◽  
Allied Health Professionals ◽  
Patient Reported

AbstractPROMs use in primary care has expanded from simply describing patient populations to contributing to decision-making, in response to the increasingly complex, ever-changing healthcare environment. In Alberta, primary care is organized into primary care networks (PCNs), where family physicians are grouped geographically and supported by allied health professionals. PCNs implement programs and services in response to local population health needs with frequent evaluation, often incorporating PROMs for this purpose. As PCN programs and services vary greatly across Alberta, so do their use of PROMs. An area of commonality is the use of the EQ-5D-5L instrument; 29 out of 41 PCNs are registered and licensed to use the instrument. It is often administrated by paper, pre- and post-program, and in combination with other specific measures, depending on the program or target population. Some PCNs share programming and therefore outcome measurement, but often the selection, implementation (including training and administration procedures) and evaluation/reporting of PROMs are unique to the PCN. As well, data analysis is largely dependent on the size and capacity of the PCN. Using PROMs for PCN program evaluation supports clinical understanding and complements clinical outcomes. PROMs describe the population attending a program, as well as provide an element of consistency when examining trends across multiple programs or timepoints. This contributes to inquiries and decisions around program development, components, administrative features, resource allocation and delivery. Challenges of PROMs use in primary care include the absence of cohesive data capture technology. This limits data capabilities and presents difficulties with data fidelity, storage, export, and analysis. Additionally, this real-world application lacks a control arm and presents methodological challenges for comparative research purposes. Furthermore, capturing long term patient outcomes poses administrative challenges of multiple follow ups. More research is required into best reporting mechanisms to ensure the data is used to its full potential. To overcome these challenges, leadership and clinician engagement are key. As well, determining consistent PCN PROM reporting requirements will ensure data are comparable across PCNs and contribute to provincial level evaluations, further supporting the movement towards overall health system quality improvement.

scholarly journals The routine collection of patient-reported outcome measures (PROMs) for long-term conditions in primary care: a cohort survey

BMJ Open ◽  
2014 ◽  
Vol 4 (2) ◽  
pp. e003968 ◽  
Author(s):  
Michele Peters ◽  
Helen Crocker ◽  
Crispin Jenkinson ◽  
Helen Doll ◽  
Ray Fitzpatrick
Keyword(s):  
Primary Care ◽  
Outcome Measures ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Long Term Conditions ◽  
Patient Reported

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

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Ian Porter ◽  
Antoinette Davey ◽  
Jaheeda Gangannagaripalli ◽  
Jonathan Evans ◽  
Charlotte Bramwell ◽  
...  
Keyword(s):  
Primary Care ◽  
Outcome Measures ◽  
Thematic Analysis ◽  
Qualitative Interviews ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Convenience Sample ◽  
Patient Reported ◽  
Primary Care Practices ◽  
High Degree

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.

scholarly journals Patient-reported outcome measures for monitoring primary care patients with depression: PROMDEP feasibility randomised trial

BMJ Open ◽  
2017 ◽  
Vol 7 (3) ◽  
pp. e015266 ◽  
Author(s):  
Tony Kendrick ◽  
Beth Stuart ◽  
Geraldine M Leydon ◽  
Adam W A Geraghty ◽  
Lily Yao ◽  
...  
Keyword(s):  
Primary Care ◽  
Outcome Measures ◽  
Randomised Trial ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Patient Reported ◽  
Primary Care Patients
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