Article Figures & Data
Tables
- Table 1. Examples of the current clinical uses of patient-reported outcomes in UK primary carea
Use Description Example Assessing severity of symptoms Highlight patients’ experiences of symptoms related to a health condition or treatment Epworth Sleep Scale67 Informing treatment decisions Inform patient—physician discussions and enable shared decision making Patient Health Questionnaire –9 (PHQ-9)68 Tracking outcomes Allows patients and providers to observe important trends, and adjust care accordingly Asthma Quality of Life Questionnaire69 Facilitating provider patient discussions Allow patients to provide information about their health, concerns, and priorities, and identify topics for discussion during the clinical visit General Health Questionnaire (GHQ-12)70 Monitoring health and wellbeing Routinely collected measures related to general health and wellbeing, provides important information about an individual’s overall health International Prostate Symptom Score (IPSS)71 aafter Lavallee et al,5 Turner et al 2019.72
Sex , n (% ) Female Male 12 (48) 13 (52) Years qualified , n (% ) 1–5 6–10 11–15 16–20 >20 4 (16) 5 (20) 9 (36) 3 (12) 4 (16) Region , n (% ) a North East East Midlands South East South West Midlands North West 4 (16) 1 (4) 5 (20) 4 (16) 5 (20) 5 (20) aOne GP was a locum and could not be allocated to a region.
- Table 3. Summary of the issues identified in relation to the key domains of the CFIR, and its existing constructs
Domain Existing CFIR construct19 Definition within CFIR19 Emergent issues I. Intervention characteristics Evidence strength and quality The stakeholder’s belief in the quality and validity of the evidence of the intervention having the desired outcome Evidence for the benefits of PROMs use in primary care Relative advantage The perceived advantage of using a particular intervention versus an alternative or existing solution PROMs may be used to frame discussions of shared-decision making, justify treatment decisions, support nursing staff Adaptability The degree to which an intervention can be refined to meet the specific needs of the local environment Ability to be digitalised Complexity The potential disruptiveness and intricacy involved in its implementation PROMs can take time to complete and to interpret and utilise results Design quality How well the intervention is assembled and presented PROMs are poorly presented to stakeholders II. Outer setting Patient needs and resources The requirements of patients and the factors that influence how they are met by an organisation Variation in patient reliability, health literacy, comorbidities External policy and incentives The strategies that policymakers and commissioners employ to spread the implementation of the intervention, include mandates, guidelines, and financial incentives Adverse influence of financial incentives, CCG III. Inner setting Implementation climate The capacity for change of an organisation through its attitude to the intervention, their relative priority, and how their use will be supported and rewarded No pressure for change, compatibility, relative priority Readiness for implementation The tangible indicators of the decision to implement a particular intervention this includes factors such as access to knowledge, information, and training GPs lack of awareness of PROMs, no systematic training IV. Characteristics of individuals Knowledge and beliefs about the intervention The attitudes of individual GPs towards any intervention as shaped by their understanding of its use and the value they place on it Considered a research tool V. Process Planning The engagement of organisations and individuals in the process of change and ensuring an appropriate plan is in place Lack of coherent approach Engagement The degree to which relevant individuals are engaged in the process of implementation Absence of consultation or staff engagement CCG = clinical commissioning group. CFIR = Consolidated Framework of Implementation Research PROMs = Patient Reported Outcome Measures.