Patient-reported outcomes in daily clinical practise in HIV outpatient care
Introduction: The use of patient-reported outcomes (PROs) in outpatient care holds promise as a tool to enhance the quality of care. The management of chronic HIV infection is multidimensional, and clinical assessment includes broad screening to identify complications. With growing constraints on ti...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2018-04-01
|
| Series: | International Journal of Infectious Diseases |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1201971218300511 |
| _version_ | 1819017918026874880 |
|---|---|
| author | Anne Sofie Høgh Kølbæk Kjær Thomas Aagaard Rasmussen Niels Henrik Hjollund Lotte Oerneborg Rodkjaer Merete Storgaard |
| author_facet | Anne Sofie Høgh Kølbæk Kjær Thomas Aagaard Rasmussen Niels Henrik Hjollund Lotte Oerneborg Rodkjaer Merete Storgaard |
| author_sort | Anne Sofie Høgh Kølbæk Kjær |
| collection | DOAJ |
| description | Introduction: The use of patient-reported outcomes (PROs) in outpatient care holds promise as a tool to enhance the quality of care. The management of chronic HIV infection is multidimensional, and clinical assessment includes broad screening to identify complications. With growing constraints on time and resources, the use of PROs may provide a much-needed tool to ensure optimal HIV care. The aim of this study was to evaluate the clinical implementation and use of a Web-based tool to collect PROs in a cohort of HIV-infected individuals. Methods: In December 2015, the PRO system AmbuFlex, a Web-based tool for self-reporting of clinical symptoms, was implemented in HIV outpatient care at Aarhus University Hospital. The HIV-specific questionnaire was designed to cover items in the European AIDS Clinical Society guidelines. Patients responded through a Web-based system from home. Based on an HIV-specific algorithm, responses were automatically assigned a green, yellow, or red colour code reflecting the severity of the symptom. HIV-related data from the electronic hospital management system were used to compare respondents and non-respondents. For cognitive and red symptoms, patient records were accessed to address whether PRO provided new information. Furthermore, it was sought to determine whether implementing PROs in clinical care can help focus the consultation on current needs. This was done by checking if a flagged symptom was assessed clinically at the following consultation. Results: Five hundred and five HIV patients were invited to participate and 277 (55%) accepted the invitation. Compared to respondents, non-respondents were significantly younger and more often female, born outside Denmark, newly diagnosed, and with a plasma viral load >50 copies/ml. Among the 262 correctly received PRO questionnaires, 104 (39%) had solely green colour-coded responses, whereas 59 (23%) had one or more red colour-coded responses. Of 69 red symptoms, 28 (41%) led to a specific clinical assessment. In many cases, PROs appeared to provide new information on cognitive (76%) and red-coded symptoms (42%). Conclusions: The use of PROs identified several cases where physical or cognitive symptoms appeared to have been unnoticed. A substantial proportion of patients reported no symptoms requiring medical attention, suggesting a potential to individualize outpatient care and redistribute resource utilization. Keywords: Human immunodeficiency virus, Patient-reported outcome, PRO, Outpatient care, Patient-centred care, Clinical decision-making |
| first_indexed | 2024-12-21T03:11:09Z |
| format | Article |
| id | doaj.art-940f0c1183c34ea48fc093ab713a0ca1 |
| institution | Directory Open Access Journal |
| issn | 1201-9712 |
| language | English |
| last_indexed | 2024-12-21T03:11:09Z |
| publishDate | 2018-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Infectious Diseases |
| spelling | doaj.art-940f0c1183c34ea48fc093ab713a0ca12022-12-21T19:17:58ZengElsevierInternational Journal of Infectious Diseases1201-97122018-04-0169108114Patient-reported outcomes in daily clinical practise in HIV outpatient careAnne Sofie Høgh Kølbæk Kjær0Thomas Aagaard Rasmussen1Niels Henrik Hjollund2Lotte Oerneborg Rodkjaer3Merete Storgaard4Department of Infectious Diseases, Aarhus University Hospital, Skejby, Denmark; Corresponding author at: Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.Department of Infectious Diseases, Aarhus University Hospital, Skejby, DenmarkWestChronic, Department of Occupational Medicine, University Research Clinic, Aarhus University, Herning, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, DenmarkDepartment of Infectious Diseases, Aarhus University Hospital, Skejby, DenmarkDepartment of Infectious Diseases, Aarhus University Hospital, Skejby, DenmarkIntroduction: The use of patient-reported outcomes (PROs) in outpatient care holds promise as a tool to enhance the quality of care. The management of chronic HIV infection is multidimensional, and clinical assessment includes broad screening to identify complications. With growing constraints on time and resources, the use of PROs may provide a much-needed tool to ensure optimal HIV care. The aim of this study was to evaluate the clinical implementation and use of a Web-based tool to collect PROs in a cohort of HIV-infected individuals. Methods: In December 2015, the PRO system AmbuFlex, a Web-based tool for self-reporting of clinical symptoms, was implemented in HIV outpatient care at Aarhus University Hospital. The HIV-specific questionnaire was designed to cover items in the European AIDS Clinical Society guidelines. Patients responded through a Web-based system from home. Based on an HIV-specific algorithm, responses were automatically assigned a green, yellow, or red colour code reflecting the severity of the symptom. HIV-related data from the electronic hospital management system were used to compare respondents and non-respondents. For cognitive and red symptoms, patient records were accessed to address whether PRO provided new information. Furthermore, it was sought to determine whether implementing PROs in clinical care can help focus the consultation on current needs. This was done by checking if a flagged symptom was assessed clinically at the following consultation. Results: Five hundred and five HIV patients were invited to participate and 277 (55%) accepted the invitation. Compared to respondents, non-respondents were significantly younger and more often female, born outside Denmark, newly diagnosed, and with a plasma viral load >50 copies/ml. Among the 262 correctly received PRO questionnaires, 104 (39%) had solely green colour-coded responses, whereas 59 (23%) had one or more red colour-coded responses. Of 69 red symptoms, 28 (41%) led to a specific clinical assessment. In many cases, PROs appeared to provide new information on cognitive (76%) and red-coded symptoms (42%). Conclusions: The use of PROs identified several cases where physical or cognitive symptoms appeared to have been unnoticed. A substantial proportion of patients reported no symptoms requiring medical attention, suggesting a potential to individualize outpatient care and redistribute resource utilization. Keywords: Human immunodeficiency virus, Patient-reported outcome, PRO, Outpatient care, Patient-centred care, Clinical decision-makinghttp://www.sciencedirect.com/science/article/pii/S1201971218300511 |
| spellingShingle | Anne Sofie Høgh Kølbæk Kjær Thomas Aagaard Rasmussen Niels Henrik Hjollund Lotte Oerneborg Rodkjaer Merete Storgaard Patient-reported outcomes in daily clinical practise in HIV outpatient care International Journal of Infectious Diseases |
| title | Patient-reported outcomes in daily clinical practise in HIV outpatient care |
| title_full | Patient-reported outcomes in daily clinical practise in HIV outpatient care |
| title_fullStr | Patient-reported outcomes in daily clinical practise in HIV outpatient care |
| title_full_unstemmed | Patient-reported outcomes in daily clinical practise in HIV outpatient care |
| title_short | Patient-reported outcomes in daily clinical practise in HIV outpatient care |
| title_sort | patient reported outcomes in daily clinical practise in hiv outpatient care |
| url | http://www.sciencedirect.com/science/article/pii/S1201971218300511 |
| work_keys_str_mv | AT annesofiehøghkølbækkjær patientreportedoutcomesindailyclinicalpractiseinhivoutpatientcare AT thomasaagaardrasmussen patientreportedoutcomesindailyclinicalpractiseinhivoutpatientcare AT nielshenrikhjollund patientreportedoutcomesindailyclinicalpractiseinhivoutpatientcare AT lotteoerneborgrodkjaer patientreportedoutcomesindailyclinicalpractiseinhivoutpatientcare AT meretestorgaard patientreportedoutcomesindailyclinicalpractiseinhivoutpatientcare |