Feasibility study for a randomised controlled trial of patient reported outcome measures (PROMs) in the assessment and follow-up

Problem

Depression is a common and disabling illness, and is largely treated in general practice. Patient reported outcome measures (PROMs) can help practitioners tailor treatment to patients, and have been shown to improve outcomes of mental health disorders in specialist psychiatric and psychological practice, but have not been subjected to a randomised trial in UK primary care.The aim of this research programme is to carry out a randomised controlled trial of PROMs for the assessment and follow-up monitoring of patients treated for depression in primary care.

Approach

A nested qualitative study within a feasibility study for the proposed RCT is being conducted in order to explore patient views of the three PROMs being tested, and their experiences of taking part. Semi-structured interviews have been carried out with patients, to explore the ease of participation; time commitment and effort needed; perceptions of the PROMs, and their utility in helping to determine appropriate treatments. Patients have also been asked about the relative practicalities of recruitment through mail-outs versus recruitment in consultations.Thematic analysis of the data has been carried out, drawing out sub-themes and themes using an iterative constant comparison approach, and seeking contrasting views where possible. Analytic rigour has been optimised using more than one analyst, data trails and cross-checking of coding strategies and interpretation, to identify evidence of bias, over-statement, and discrepancies between the data and initial themes.

Findings

Initial findings suggest that patients have been positive about the concept of and their involvement in the study, with motivation to take part including the desire to help others with the illness, to help with research, and the potential of some self-benefit. In terms of the trial design, all patients have reported value in being involved but highlighted problems in using PROMs due to issues surrounding follow-up appointments, such as seeing different GPs who had not been trained to use PROMs during practice set-up.

Consequences

Preliminary findings suggest that patients are willing to be involved in the proposed main study, and the use of PROMs may be beneficial to patients as it enables them to provide personal feedback to their GP. Encouraging patients to have a greater involvement in their management of depression may benefit both the patient at an individual level, as well as reducing the burden of depression on the NHS.