How could a Patient-Reported Outcome Measure (PROM) for Long-term Conditions (LTCs) improve Patient Care? Patients' and Health and Social Care Stakeholders' Perspectives

Conference: 
SAPC ASM 2015 - Oxford - Evidence and innovation in primary care
Talk Code: 
3B.5

The problem

Health and social care services are faced with the challenge of providing efficient, effective care for the 15 million people in England living with long-term conditions (LTCs). Patient-Reported Outcome Measures (PROMs) are self-report questionnaires that aim to capture patients’ views on health-related outcomes. There is evidence that PROMs can enhance patient-practitioner communication and improve problem detection/monitoring at the individual level. At the aggregate level, PROMs have been mooted as tools to inform commissioning, performance monitoring and quality improvement, although to date, routine collection of PROMs focuses on elective surgeries rather than LTCs. There is potential that an LTC PROM, used across health and social care, could aid integration of services and thereby improve patient care. This study aimed to investigate stakeholder and patient views on the uses, value, and potential pitfalls of using one PROM across all LTCs.

The approach

Semi-structured interviews were conducted with 31 stakeholders in primary care, secondary care, social care, policy, and patient-focused voluntary organisations in England; and 42 adults with a range of LTCs spanning physical and mental health, single- and multi-morbidity. Interviews were transcribed verbatim and analysed using a framework approach.

Findings

The idea of a PROM that captured outcomes across LTCs was valued by both patients and professional stakeholders. Professional stakeholders endorsed using a PROM to improve services through guiding patient-practitioner conversations; aligning services to shared outcomes (outcomes-based commissioning); and enhancing patient engagement with their own care. Patients foresaw benefits in using a PROM to prompt self-reflection on their health, to enable patient-practitioner dialogue, and to aid patients’ problem-solving in collaboration with practitioners. Patients also saw the value of PROM data for improving practitioners’ comprehension of patients’ needs. Both groups saw an LTC PROM as a tool that could both enable self-management and support a more collaborative approach to care. However, both groups were concerned with how to meaningfully implement a PROM in light of constrained public services, mentioning barriers such as time constraints on consultations and poor communication across services. Both groups felt that an LTC PROM needed to be implemented in the context of a trusted relationship to enable open dialogue, and that there needed to be a clear link between the PROM and actions to improve care.

Consequences

Both groups prioritised a PROM used at the individual level, to enhance people’s abilities to self-manage and to guide service provision. However, implementation is seen as the key challenge. For an LTC PROM to be useful in practice, it will need to be co-developed and implemented with input from both patients and front-line practitioners.

Credits

  • Cheryl Hunter, Faculty of Health Sciences, University of Southampton, Southampton, UK
  • Caroline Potter, Faculty of Health Sciences, University of Southampton, Southampton, UK
  • Laura Kelly, Faculty of Health Sciences, University of Southampton, Southampton, UK
  • Crispin Jenkinson, Faculty of Health Sciences, University of Southampton, Southampton, UK
  • Julien Forder, PSSRU, London School of Economics, London, UK
  • Angela Coulter, Faculty of Health Sciences, University of Southampton, Southampton, UK
  • Anne-Sophie Darlington, PSSRU, University of Kent, Canterbury, UK
  • Ray Fitzpatrick, Faculty of Health Sciences, University of Southampton, Southampton, UK
  • Michele Peters, Faculty of Health Sciences, University of Southampton, Southampton, UK