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Patient-reported outcomes in RA care improve patient communication, decision-making, satisfaction and confidence: qualitative results

Author

Bartlett SJ1,2, De Leon E2,3, Orbai AM2, Haque UJ2, Manno RL2, Ruffing V2, Butanis A2, Duncan T2, Jones MR2, Leong A4, Perin J5, Smith KC3, Bingham CO2. Rheumatology (Oxford). 2019 Oct 30. pii: kez506. doi: 10.1093/rheumatology/kez506. [Epub ahead of print]

Author Information

1 Divisions of Clinical Epidemiology, Rheumatology and Respiratory Epidemiology and Clinical Trials Unit, McGill University, Center for Outcomes Research, Montreal, QC, Canada.

2 Division of Rheumatology, Department of Medicine, Johns Hopkins University.

3 Center for Qualitative Studies in Health and Medicine, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

4 Healthy Motivation, Santa Barbara, CA.

5 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

Abstract

OBJECTIVE: 

To evaluate the impact of integrating patient-reported outcomes (PROs) into routine clinics, from the perspective of patients with RA, clinicians and other staff.

METHODS: 

We conducted a prospective cohort study using a mixed methods sequential explanatory design at an academic arthritisclinic. RA patients completed selected Patient-Reported Outcomes Measurement Information System measures on tablets in the waiting room. Results were immediately available to discuss during the visit. Post-visit surveys with patients and physicians evaluated topics discussed and their impact on decision making; patients rated confidence in treatment. Focus groups or interviews with patients, treating rheumatologists and clinic staff were conducted to understand perspectives and experiences.

RESULTS: 

Some 196 patients and 20 rheumatologists completed post-visit surveys at 816 and 806 visits, respectively. Focus groups were conducted with 24 patients, 10 rheumatologists and 4 research/clinic staff. PROs influenced medical decision-making and RA treatment changes (38 and 18% of visits, respectively). Patients reported very high satisfaction and treatment confidence. Impact on clinical workflow was minimal after a period of initial adjustment. PROs were valued by patients and physicians, and provided new insight into how patients felt and functioned over time. Reviewing results together improved communication, and facilitated patient-centred care, shared decision making, and the identification of new symptoms and contributing psychosocial/behavioural factors.

CONCLUSION: 

PRO use at RA visits was feasible, increased understanding of how disease affects how patients feel and function, facilitated shared decision-making, and was associated with high patient satisfaction and treatment confidence.