Department of Infectious Diseases, Aarhus University Hospital, Skejby, Denmark.
Department of Infectious Diseases, Aarhus University Hospital, Skejby, Denmark.
Int J Infect Dis. 2018 Apr;69:108-114. doi: 10.1016/j.ijid.2018.02.015. Epub 2018 Feb 21.
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.
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.
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%).
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.
在门诊护理中使用患者报告的结果（PROs）有望成为提高护理质量的工具。慢性 HIV 感染的管理是多方面的，临床评估包括广泛的筛查以识别并发症。随着时间和资源的限制越来越大，使用 PROs 可能提供一种急需的工具，以确保最佳的 HIV 护理。本研究的目的是评估在感染 HIV 的个体队列中使用基于网络的工具收集 PROs 的临床实施和使用情况。
2015 年 12 月，基于网络的 PRO 系统 AmbuFlex 在奥胡斯大学医院的 HIV 门诊护理中实施。HIV 特异性问卷旨在涵盖欧洲艾滋病临床学会指南中的项目。患者在家中通过基于网络的系统进行回答。根据 HIV 特异性算法，反应自动分配绿色、黄色或红色代码，反映症状的严重程度。从电子医院管理系统中获取与 HIV 相关的数据，以比较应答者和非应答者。对于认知和红色症状，访问患者记录以确定 PRO 是否提供了新信息。此外，还试图确定在临床护理中实施 PRO 是否有助于将咨询重点放在当前需求上。这是通过检查在随后的咨询中是否评估了标记的症状来完成的。
共邀请了 505 名 HIV 患者参加，277 名（55%）接受了邀请。与应答者相比，非应答者明显更年轻，且更常为女性，出生在丹麦以外，新诊断，血浆病毒载量>50 拷贝/ml。在 262 份正确收到的 PRO 问卷中，104 份（39%）仅有绿色编码反应，而 59 份（23%）有一个或多个红色编码反应。在 69 个红色症状中，28 个（41%）导致了特定的临床评估。在许多情况下，PROs 似乎提供了认知（76%）和红色编码症状（42%）的新信息。
使用 PROs 发现了一些似乎未被注意到的身体或认知症状的情况。相当一部分患者报告没有需要医疗关注的症状，这表明有可能对门诊护理进行个性化，并重新分配资源利用。
