Perspectives of patients and professionals on the use of patient-reported outcome measures in primary care: a systematic review of qualitative studies
Although the use of patient-reported outcome measures (PROMs) in healthcare settings has increased substantially over recent years, there is potential for them to play a greater role in primary care. The underlying goals of this study were to review and summarise studies on patients and healthcare professionals’ perspectives about the use of PROMs in primary care, to identify barriers and enablers to their use.
A systematic search was conducted in Medline, Embase, PsychInfo and CINAHL from inception until 2016, and further relevant references were retrieved through snowballing. Five independent reviewers screened all the references for ascertaining eligibility. Studies conducted in primary care settings using qualitative methods exploring patients and/or healthcare professionals perspectives on the clinical utility of using PROMs in clinical practice.
19 studies met the inclusion criteria (4 after 2012) 11 of which were conducted in the UK, the others took place in Netherlands (2), Sweden (2), USA (2), Germany (1) and Norway (1). Studies reported on the views of only professionals (8), only patients (5), and both professionals and patients. The majority of studies (12) focused on mood disorders, and the PROMs most commonly reported on were the Edinburgh Postnatal Depression Scale (EPDS),Beck Depression Inventory (BDI), Patient Health Questionnaire (PHQ-9) and the Hospital Anxiety and Depression Scale (HADS). Patients reported benefits associated with PROMs such as increased awareness, alertness, self-management, feeling validated, and being able to discuss problems they would not otherwise mention. Concerns were also raised about PROMs replacing face-to-face consultations, and restricting discussion, along with concerns about stigma and being identified by illness(es). Professionals reported PROMs to be useful for aiding clinical decisions, monitoring and management options, and aiding a better understanding of the longitudinal life of patients. Although some valued PROMs for facilitating communication and opening up, others found they undermined the human element of consultations, along with professional intuition and judgement. Burden on GP time was also noted.
Patients and professional highlighted a number of benefits of using PROMs in clinical practice, particularly in terms of supporting decision making, patient awareness and management/self-management options. However, patients and professionals both voiced concerns about PROMs potentially undermining relational continuity of care, which constitutes a major barrier that needs to be addressed in the future implementation of PROMs in primary care.