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Identifying barriers to the implementation of patient-reported outcome measures using a theory-based approach

Andria Hanbury

Abstract


Rationale, aims and objectives: Patient-reported outcome measures (PROMs) are gaining increasing attention within mental healthcare, yet can be difficult to implement into routine practice. To increase uptake, it is recommended to explore the barriers to uptake guided by a theory base, with this information then used to design a tailored improvement strategy. The aim of this study was to explore the barriers to collecting and using a specific PROM within a single setting to inform the design of PROMs promotion strategies.

Methods: Staff perceptions of relative advantage and the compatibility with norms and complexity of using the Short Warwick Edinburgh Mental Wellbeing Scale (SWEMWBS) in routine practice were explored through structured group discussions with mental healthcare teams within one Foundation Trust guided by diffusion of innovation theory.

Results: Respondents perceived some advantages to using SWEMWBS, notably patient involvement, but also highlighted the burden of paper-based data collection and the poor quality of feedback reports. There was also scepticism regarding the suitability of the tool, particularly for certain groups of patients and concerns regarding use of PROMs for performance management. Views were mixed regarding compatibility with existing norms.

Conclusions: To increase uptake, it is recommended that the positive perceptions of relative advantage, compatibility and ease of use identified in this study should be promoted, including through messages delivered by senior staff and tailored educational strategies. Negative (mis)perceptions should be similarly challenged and barriers around paper-based data collection and feedback reports systematically targeted.


Keywords


Barriers, clinician-reported outcome measures, doctor-patient communication, implementation, patient mediated interventions, patient-reported outcomes, person-centered healthcare, quality improvement, theory

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References


Royal College of Psychiatrists. (1996). Health of the Nation Outcome Scales (HoNOS) © Royal College of Pyschiatrists 1996.

Marshall, S., Haywood, K. & Fitzpatrick, R. (2005). Impact of patient-reported outcome measures on routine practice: a structured review. Journal of Evaluation in Clinical Practice 12 (5) 559-568.

Knaup, C., Koesters, M., Schoefer, D., Becker, T. & Puschner, B. (2009). Effect of feedback of treatment outcome in specialist mental healthcare: meta-analysis. British Journal of Psychiatry 195 (1) 15-22.

Effective Practice and Organisation of Care (EPOC). (2015). EPOC Taxonomy. Available at: http://epoc.cochrane.org/epoc-taxonomy.

Grimshaw, J.M., Thomas, R.E., MacLennan, G., Fraser, C., Ramsey, C.R., Vale, L., Whitty, P., Eccles, M.P., Matowe, L., Shirran, L., Wensing, M., Dijkstra, R. & Donaldson, C. (2004). Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technology Assessment 8 (6) 1-72.

Carlier, I.V., Meuldijk., D., van Vliet, I.M., van Fenema, E., van der Wee, N.J. & Zitman, F.G. (2012). Routine outcome monitoring and feedback on physical or mental health status: evidence and theory. Journal of Evaluation in Clinical Practice 18 (1) 104-110.

Boyce, M.B. & Browne, J.P. (2013). Does providing feedback on patient-reported outcomes to healthcare professionals result in better outcomes for patients? A systematic review. Quality Life Research 22, 2265-2278.

Ivers, N., Jamtvedt, G., Flottorp, S., Young, J.M., Odgaard-Jensen, J., French, D., O’Brien, M.A., Johansen, M., Grimshaw, J. & Oxman, A.D. (2012). Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews Issue 6, CD000259.

Antunes, B., Harding, R. & Higginson, I.J. (2014). Implementing patient-reported outcome measures in palliative care clinical practice: a systematic review of facilitators and barriers. Palliative Medicine 28 (2) 158-175.

Boyce, M.B., Brown, J.P. & Greenhalgh, J. (2013). The experiences of professionals with using information from patient reported outcomes to improve the quality of health care: a systematic review of qualitative research. BMJ Quality and Safety 23 (6) 508-518.

Craig, P., Dieppe, P., Macintyre, S., Michie, S., Nazareth, I. & Pettigrew, M. (2008). Complex Interventions Guidance. Medical Research Council. [http://www.mrc.ac.uk/Utilities/Documentrecord/index.htm?d=MRC004871, 2008]

Stewart-Brown, S., Tennant, A., Tennant, R., Platt, S., Parkinson, J. & Weich, S. (2009). Internal construct validity of the Warwick Edinburgh Mental Wellbeing Scale (WEMWBS): a Rasch analysis using data from the Scottish Health Education Population Survey. Health and Quality of Life Outcomes, 7,15.

Michie, S., Johnston, M., Francis, J., Hardeman, W. & Eccles, M. (2008). From theory to Intervention: Mapping

theorectically derived behavioural determinants to behaviour change techniques. Applied Psychology 57 (4) 660-680.

Cane, J., Richardson, M., Johnston, M., Ladha, R. & Michie, S. (2014). From lists of behaviour change techniques to structured hierarchies: comparison of two methods of developing a hierarchy of BCTs. British Journal of Health Psychology 20 (1) 130-150.

Department of Health (2013). Mental Health Payment by Results Guidance for 2013-14. Department of Health Payment by Results Team. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/232162/Mental_Health_PbR_Guidance_for_2013-14.pdf. Accessed 13th April 2016.

Tennant, R., Hiller, L., Fishwick, R., Platt, S., Joseph, S., Weich, S., Parkinson, J., Secker, J. & Stewart-Brown, S. (2007). The Warwick Edinburgh Mental Wellbeing Scale: development and UK validation. Health and Quality of Life 5 (63) doi:10.1186/1477-7525-5-63.

Krause, J., Van Lieshout, J., Klomp, R., Huntink, E., Aakhus, E., Flottorp, S., Jaeger, C., Steinhaeuser, J., Godycki-Cwirko, M., Kowalczyk, A., Agarwal, S., Wensing, M. & Baker, R. (2015). Identifying determinants of care for tailoring implementation in chronic diseases: an evaluation of different methods. Implementation Science 9 (102) doi: 10.1186/s 130-014-012-3.

Hanbury, A., Farley, K. & Thompson, C. (2015). Cost and feasibility: an exploratory case study comparing use of a literature review method with questionnaires, interviews and focus groups to identify barriers for a behaviour-change intervention. BMC Health Services Research 15 (211) 1-8.

Rogers, E.M. (1995). Diffusion of innovations. New York: Free Press.

Greenhalgh, T., Robert, G., MacFarlane, F., Bate, P. & Kyriakidou, O. (2004). Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Quarterly 82 (4) 581-629.

Scott, S.D., Plotnikoff, R.C., Karunamuni, N., Bize, R., Rodgers, R. (2008). Factors influencing the adoption of an innovation: an examination of the uptake of the Canadian Heart Health Kit. Implementation Science, 3 (41) doi:10.1186/1748-5908-3-41

Flodgren, G., Parmelli, E., Doumit, G., O’Brien, M.A., Grimshaw, J. & Eccles, M. (2011). Local opinion leaders: effects on professional practice and health care outcomes (Review). Cochrane Database of Systematic Reviews 8. doi: 10.1002/14651858.CD000125.pub4.

Care Pathways and Packages Project. (2014). Results for pilot of the short version of the Warwick Edinburgh Mental Wellbeing Scale. Final Report. Available at: http://www.cppconsortium.nhs.uk/. Accessed on 12 April 2016.

Smith, S.C., Lamping, D.L., Banerjee, S., Harwood, R., Foley, B., Smith, P., Cook, J.C., Murray, J., Prince, M., Levin, E., Mann, A. & Knapp, M. (2005). Measurement of health-related quality of life for people with dementia: development of a new instrument (DEMQOL) and an evaluation of current methodology. Health Technology Assessment 9 (10) 1-93.

Dearing, J.W. (2009). Applying diffusion of innovation theory to intervention development. Research on Social Work Practice 19 (503) 503-518.

Michie, S., Johnston, M., Abraham, C., Lawton, R., Parker, D. & Walker, A. [2005]. Making psychological theory useful for implementing evidence based practice: a consensus approach. Quality and Safety in Health Care 14, 26-33.

Forsetlund, L., Bjørndal, A., Rashidian, A., Jamtvedt, G., O’Brien, M.A., Wolf, F.M., Davis, D., Odgaard-Jensen, J. & Oxman A.D. (2009). Continuing education meetings and workshops: effects on professional practice and health care outcomes (review). Cochrane Database of Systematic Reviews. (2), CD003030.

O’Brien, M.A., Rogers, S., Jamvedt, G., Oxman, A.D., Odgaard-Jensen, J., Kristoffersen, D.T., Forsetlund, L., Bainbridge, D., Freemantle, N., Davis, D., Haynes, R.B. & Harevy, E. (2007). Educational outreach visits: effects on professional practice and health care outcomes (review). Cochrane Database of Systematic Reviews, 4, CD00409.

Giguère, A., Légaré, F., Grimshaw, J., Turcotte, S., Fiander, M., Grudniewicz, A., Makosso-Kallyth, S.,

Wolf, F.M., Farmer, A.P. & Gagnon, M.P. (2012). Printed educational materials: effects on professional

practice and healthcare outcomes. Cochrane Database of Systematic Reviews: CD004398.

Grimshaw, J.M., Eccles M,P., Greener, J., Maclennan, G., Ibbotson, T., Kahan, J.P. & Sullivan, F. (2006). Is the involvement of opinion leaders in the implementation of research findings a feasible strategy? Implement Science 1 (3).

Farley, K., Hanbury, A. & Thompson, C. (2013). Gathering opinion leader information for a tailored implementation intervention in secondary healthcare: a randomised trial. BMC Medical Research Methodology, 14, 38. doi: 10.1186/1471-2288-14-38.




DOI: http://dx.doi.org/10.5750/ejpch.v5i1.1202

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