Can practitioners use patient reported measures to enhance person centred coordinated care in practice? A qualitative study

Abstract

BackgroundTo ascertain whether person centred coordinated care (P3C) is being delivered in healthcare services, components relating to the construct need to be measured. Patient reported measures (PRMs) can be used to provide a measurement of patients’ experiences of P3C. Traditionally, they have been used to assess whether interventions are delivering P3C. Recently there has been an increased interest in using them to directly enhance P3C in clinical practice by, for example, improving practitioner-patient communication. However, there is limited research available on how P3C can be implemented in practice. This study aimed to extend this literature base by exploring how professionals use PRMs to enhance P3C.MethodsCross sectional thematic analysis of 26 semi-structured interviews with a variety of professionals who have experience of how PRMs can be used to make improvements to P3C. Inductive themes were mapped onto components of P3C care that fell under five established domains of P3C (Information and Communication; My Goals/Outcomes; Decision making; Care Planning and Transitions) to explore whether and how individual components of P3C were being improved through PRMs. Barriers and facilitators that affected the delivery and the results of the PRMs were also identified.ResultsThree P3C domains (Information and Communication, My Goals/Outcomes and Care Planning) were mapped frequently onto themes generated by the participants’ interviews about PRM use. However, the domain ‘Decision Making’ was only mapped onto one theme and ‘Transitions’ was not mapped at all.Participant reports suggested that PRM use by practitioners enhanced patients’ ability to self-manage, communicate, engage and reflect during consultations. Barriers to PRM use were related to a lack of a whole service approach to implementation.ConclusionsPractitioners use both PROMs and PREMs in various ways to improve different aspects of patient care. By sharing experiences professionals can benefit from each other’s learning and work together to extend the potential value that PRMs can offer to P3C delivery.

Supporting Innovative Person-Centred Care in Financially Constrained Environments: The WE CARE Exploratory Health Laboratory Evaluation Strategy

“…It might also be necessary (providing sufficient justification and acceptability from practitioners and patients) that focused data capture on a specific element of the delivery is added into the core set of measures at particular times. For example, if communication or shared decision-making was an improvement target, implementing a tool that specifically addresses this issue of relational care could be used as both the intervention and data collection [75].…”

Using the Consolidated Framework for Implementation Research to describe the implementation of Patient Reported Outcome Measures (PROMs) in routine primary care

“…Of particular interest is that multiple digital platforms can enable the independent completion of PROMs by patients whilst producing readily interpretable outputs for both patients and clinicians [42] for example the use of computer adaptive testing in mental health [43][44][45]. However ease of use is not sufficient to encourage uptake without coherent and clearly communicated evidence of the benefit of using PROMs in routine primary care [18]. One frequently reported advantage is their ability to support clinician-patient communication [46][47][48][49] contributing to improved quality and experience of care [48,[50][51][52][53][54][55][56].…”

“…PROMs have the ability to encourage patient engagement [18,59,67] and, where their use is sympathetic to their needs and abilities [68][69][70] patients considered them a valuable opportunity to receive clinical guidance or feedback [67]. This is in contrast to busy clinicians for whom PROMs exemplify the excess of data they are expected to review [67].…”

“…For any intervention, planning is essential [42,68] and a whole systems approach that flows from policymakers to individual providers has been recommended for implementing PROMs in primary care [18]. However, a coherent national strategy for PROM implementation is yet to emerge [6,73] and the perceptions of GPs we spoke to reflected those expressed by some clinicians in secondary care that felt completing and utilising PROMs fell outside the bounds of their professional responsibility, an attitude encouraged by their continued absence from clinical guidelines [46].…”

“…Despite the broad scope of their use we know little of how successfully PROMs have been integrated into primary care or of the benefits that result [16]. However, if their potential for systematically supporting person centred care is to be realised then we must first understand the factors impacting their existing implementation including the influences of patients, providers and organisational context [4,5,14,[17][18][19][20][21]. Identifying and understanding the contextual influences on implementation within the complicated and shifting environment of modern healthcare [22,23] has led to recommendations for a framework-based approach [24,25] and one which has successfully unpicked this complexity across multiple healthcare settings [26] is the Consolidated Framework for Implementation Research (CFIR) [27,28].…”