Introduction
Method
Online survey
Qualitative study
Data analysis
Results
Online survey
Number | ||
---|---|---|
Years GMC GP Register | ≤10 | 35 |
11–20 | 44 | |
≥21 | 21 | |
Primary role | Salaried | 25 |
Locum | 16 | |
Partner | 62 | |
Academic | 4 | |
Commissioner | 4 | |
Other | 1 | |
Full/ part time | Full time | 64 |
Part time | 36 | |
Rurality of GP practice | Urban | 38 |
Suburban | 43 | |
Rural | 13 | |
Both | 6 | |
Region of GP practice | East of England | 9 |
East Midlands | 9 | |
London | 15 | |
North East | 6 | |
North West | 11 | |
South Central | 10 | |
South East Coast | 8 | |
South West | 11 | |
West Midlands | 11 | |
Yorkshire and Humber | 10 |
Question | Multiple choice answer | Number |
---|---|---|
What do you currently use PROMs for?a | To aid clinical management | 66 |
As a screening/diagnostic tool | 61 | |
Facilitate shared-decision making | 48 | |
To improve efficiency of consultation | 45 | |
Facilitate communication with patients | 42 | |
For Chronic disease monitoring | 38 | |
To support personalised care planning and self-management | 31 | |
Facilitate communication across different healthcare sector | 28 | |
Monitor performance | 25 | |
For triage | 14 | |
To monitor safety/adverse events | 12 | |
Facilitate communication between patients and family members/ carers | 11 | |
Reward performance | 10 | |
Research | 5 | |
Other | 2 | |
None – I don’t currently use PROMs | 19 | |
How do you access PROMs?a | Through clinical systems | 56 |
Embedded within clinical templates | 49 | |
Online | 47 | |
Paper | 29 | |
Other | 3 | |
N/A – I don’t access PROMs | 11 | |
When do your patients complete PROMs?a | During the consultation: face-to-face | 72 |
Prior to consultation: at home at the request of a healthcare professional | 22 | |
Prior to consultation: in the waiting room | 12 | |
During the consultation: telephone | 9 | |
Prior to consultation: at home, instigated by the patient | 2 | |
Other | 20 | |
N/A – my patients don’t currently complete PROMs | 17 | |
How do your patients complete PROMs?a | Paper | 68 |
Interview: in person (doctor) | 51 | |
Interview: in person (nurse) | 18 | |
Interview: over the phone (doctor) | 13 | |
Interview: over the phone (nurse) | 6 | |
Online | 5 | |
Completed by a proxy on behalf of patients | 5 | |
Through an app | 3 | |
N/A – my patients don’t currently complete PROMs | 15 | |
Who reviews the results of PROMs?a | Doctor | 84 |
Nurse | 17 | |
Other | 3 | |
N/A – my patients don’t currently complete PROMs | 15 | |
What do you think are the main barriers to use of PROMs?b | Time constraints | 77 |
Mandated to complete | 55 | |
Sufficient understanding without PROMS | 32 | |
Patients dislike questionnaires | 31 | |
Uncertainty about reliability | 27 | |
Perceived as cost-cutting | 21 | |
Constrain doctor-patient relationship | 18 | |
Lack of integration into clinical systems | 13 | |
Feels uncomfortable | 11 | |
Number of measures | 10 | |
Lack of confidence in interpreting | 8 | |
Other | 4 | |
None | 1 | |
How do you think your patients feel about completing PROMs?c | Negative (e.g. chore, tick box, not interested) | 22 |
Positive (e.g. happy to complete, time saving, longitudinal outcomes) | 47 | |
Neutral | 31 |
Question | Multiple choice answer | Number |
---|---|---|
Where do you think PROMs could provide the most benefit?a | To aid clinical management | 66 |
As a screening/diagnostic tool | 62 | |
Facilitate shared-decision making | 60 | |
Facilitate communication with patients | 43 | |
To support personalised care planning and self-management | 39 | |
For chronic disease monitoring | 34 | |
To improve efficiency of consultation | 31 | |
Monitor performance | 31 | |
Facilitate communication across different healthcare sectors | 22 | |
Facilitate communication between patients and family members/ carers | 17 | |
For triage | 16 | |
Research | 16 | |
To monitor safety/ adverse events | 15 | |
Reward performance | 7 | |
None – I don’t think PROMs provide a benefit | 5 | |
How would you prefer to access PROMs?a | Embedded within clinical templates | 65 |
Through clinical systems | 63 | |
Online | 27 | |
Paper | 16 | |
Other | 1 | |
NA – I don’t want to access PROMs | 4 | |
When do you think patients would prefer to complete PROMs? | During the consultation: face-to-face | 34 |
Prior to consultation: at home at the request of a healthcare professional | 25 | |
Prior to consultation: in the waiting room | 20 | |
Prior to consultation: at home, instigated by the patient | 11 | |
During the consultation: telephone | 1 | |
Other | 5 | |
NA – I don’t think my patients will complete PROMs | 4 | |
What would the best format be for patients to complete PROMs? | Paper | 43 |
Online | 21 | |
Interview: in person (doctor) | 16 | |
Through an app | 8 | |
Interview: in person (nurse) | 3 | |
Interview: over the phone (doctor) | 1 | |
Interview: over the phone (nurse) | 1 | |
Other | 4 | |
N/A – I don’t think my patients should complete PROMs | 3 | |
Who do you think should ideally review the results of PROMs? | Doctors | 78 |
Nurses | 7 | |
Other (please specify) | 15 | |
How frequently do you think PROMs should be used for chronic disease monitoring? | Annually | 36 |
As prescribed | 27 | |
Monthly | 13 | |
Whenever the patient choses | 9 | |
Prior to every consultation | 8 | |
I don’t think there is a role for PROMs in chronic disease monitoring | 7 | |
What format for recording results would you prefer for PROMs? | Electronic (as part of the electronic health record) | 78 |
Paper | 11 | |
Electronic (patient portal) | 10 | |
Telephone | 1 | |
Do you think development of PROM systems should be: | Designed to meet clinician/patient needs (Bottom up approach) | 68 |
Try to meet both objectives | 29 | |
Designed primarily for audit, benchmarking or commissioning (Top down approach) | 3 | |
Which of your patients do you think would benefit the most from completing PROMs?b | Mental health patients | 20 |
All / most patients | 15 | |
Patients with chronic conditions | 14 | |
Unsure | 8 | |
Patients interested in PROMs | 8 | |
None/very few patients | 6 | |
Patients who struggle to communicate/articulate symptoms | 6 | |
Younger patients | 4 | |
Educated/literate patients | 3 | |
Cognitive impairment patients | 2 | |
Other | 35 | |
Is there anything that facilitates/supports the use of PROMs in primary care?b | Integrated clinical systems | 29 |
More Time | 12 | |
Easy access | 12 | |
Unsure | 9 | |
Ease of use | 9 | |
Training, knowledge, experience | 7 | |
None | 21 | |
Other | 22 |
Qualitative study
Variable | Number (%) | |
---|---|---|
Sex | Male | 14 (58) |
Female | 11 (42) | |
Years qualified | < 5 | 3 (12) |
5–10 | 7 (28) | |
11–20 | 10 (40) | |
21–30 | 3 (12) | |
> 30 | 2 (8) | |
Region | North East | 5 (20) |
North West | 4 (16) | |
East Midlands | 1 (4) | |
West Midlands | 5 (20) | |
South | 3 (12) | |
South East | 6 (24) | |
South West | 1 (4) |
Current use of PROMs
“It does help direct the discussion regarding future management, especially the mental health patients because it allows them to objectively score how they feel and what’s going on, and allows me to help discuss treatment options with them.” GP12
“I have sometimes filled in the questionnaires with the patients, and actually I see the value of that because we actually get a better picture with the discussion around filling the form with the patient as opposed to just getting a figure just attached to the referral letter.” GP13
Facilitators to PROM use
“For me I am quite evidence based personally, and if someone was to show me like you’re doing, if I’m the outlier and most GPs love PROMs and I would actually be thinking hand on I’m the outlier here, actually maybe I’ll just get more on board. If there was a study saying this particular PROM if they said PHQ-9 shortened a ten minute consultation down to five minutes, improves on patient outcomes, reduces re-attendance rates, improve compliance to medications, then I would say right we’ve got to get on board and do that.” GP18
“ … I am unlikely to go and start using some new coeliac disease PROM when I have just been to a talk from a private gastroenterologist or something like that. I am more likely to use something that is appearing to me in lots of different areas of my CPD or medical education. So if I might see a paper about it, and then I might hear a colleague talking about it, and then I might see something on GP Notebook or something like that. So you’re getting over exposed to it, and then try it out and see how well it resonates, and how useful it is and how quick and easy to remember it is.” GP24
Barriers to PROM use
“ … sometimes the patient can fill them in with what they think the clinician might want them to say rather than what they actually feel. So sometimes patients can underplay their symptoms, and equally sometimes patients can overplay their symptoms if there might be some perhaps secondary gain for them in terms of certification from work or whether they want some help with some other part of their care. So I think they can potentially be a bit skewed by that.” GP19
“so the big one is PHQ-9, it’s pushed very hard and for example with people with chronic diseases as well it flags up in the QOF box on EMIS. But in reality it’s irrelevant to assisting you that much in terms of referral and management, so there’s no point in doing it.” GP18
“In a pressurised rushing surgery and you’ve only got ten minutes the person usually would need at least 20 minutes to solve their issues, and if you were to include a questionnaire on top of that you would be definitely talking about 30 minutes at least, and you can’t afford to be doing that on a regular basis. You can do it as a one off thing and then you have an idea, but you would be pressurised to just do things quickly...” GP2
“So we do have some which are integrated into the system, but they are not quite integrated enough to be user friendly, … I’m actually thinking here of the dementia screening test which isn’t really a PROM I guess, but you have to input the data and then the score is added up wrong because the template is set up wrong, so you end up having to override it and do it yourself anyway which makes it a bit of a waste of time it being integrated, and I think sometimes with the clunky way that clinical computer systems sometimes work it be difficult during the consultation to use that tool there and then. So I think there could be better integration, it could be more fluid, and I suppose depends on which clinical system is used, which PROMs are used locally and how easy they are to integrate into the system, because I guess some are going to be more objective than others.” GP19
“To make me want to use a PROM first of all I would have to hear about it, and that is the main problem that we wouldn’t hear about it and therefore people get them on committees as mandatory things to put down on referrals. That happens because we don’t hear … ” GP20