Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
Regenstrief Institute, Indianapolis, IN, USA.
J Gen Intern Med. 2018 Aug;33(8):1245-1252. doi: 10.1007/s11606-018-4391-0. Epub 2018 Apr 5.
Symptoms account for more than 400 million clinic visits annually in the USA. The SPADE symptoms (sleep, pain, anxiety, depression, and low energy/fatigue) are particularly prevalent and undertreated.
To assess the effectiveness of providing PROMIS (Patient-Reported Outcome Measure Information System) symptom scores to clinicians on symptom outcomes.
Randomized clinical trial conducted from March 2015 through May 2016 in general internal medicine and family practice clinics in an academic healthcare system.
Primary care patients who screened positive for at least one SPADE symptom.
After completing the PROMIS symptom measures electronically immediately prior to their visit, the 300 study participants were randomized to a feedback group in which their clinician received a visual display of symptom scores or a control group in which scores were not provided to clinicians.
The primary outcome was the 3-month change in composite SPADE score. Secondary outcomes were individual symptom scores, symptom documentation in the clinic note, symptom-specific clinician actions, and patient satisfaction.
Most patients (84%) had multiple clinically significant (T-score ≥ 55) SPADE symptoms. Both groups demonstrated moderate symptom improvement with a non-significant trend favoring the feedback compared to control group (between-group difference in composite T-score improvement, 1.1; P = 0.17). Symptoms present at baseline resolved at 3-month follow-up only one third of the time, and patients frequently still desired treatment. Except for pain, clinically significant symptoms were documented less than half the time. Neither symptom documentation, symptom-specific clinician actions, nor patient satisfaction differed between treatment arms. Predictors of greater symptom improvement included female sex, black race, fewer medical conditions, and receiving care in a family medicine clinic.
Simple feedback of symptom scores to primary care clinicians in the absence of additional systems support or incentives is not superior to usual care in improving symptom outcomes.
clinicaltrials.gov identifier: NCT02383862.
在美国，每年有超过 4 亿次门诊就诊是由于症状引起的。SPADE 症状（睡眠、疼痛、焦虑、抑郁和低能量/疲劳）特别普遍，但治疗不足。
评估向临床医生提供 PROMIS（患者报告的结果测量信息系统）症状评分对症状结果的有效性。
2015 年 3 月至 2016 年 5 月在学术医疗保健系统中的普通内科和家庭实践诊所进行的随机临床试验。
筛查出至少有一种 SPADE 症状阳性的初级保健患者。
在就诊前立即通过电子方式完成 PROMIS 症状测量后，300 名研究参与者被随机分配到反馈组，其中他们的临床医生收到症状评分的视觉显示，或对照组，其中不向临床医生提供评分。
主要结果是 SPADE 综合评分的 3 个月变化。次要结果是个别症状评分、诊所记录中的症状记录、症状特异性临床医生行动和患者满意度。
大多数患者（84％）有多种临床显著（T 评分≥55）SPADE 症状。两组均表现出中度症状改善，但与对照组相比，反馈组有适度的改善趋势（复合 T 评分改善的组间差异，1.1；P=0.17）。在 3 个月的随访中，只有三分之一的基线存在的症状得到解决，并且患者经常仍需要治疗。除疼痛外，临床上显著的症状记录不到一半的时间。治疗组之间的症状记录、症状特异性临床医生行动和患者满意度均无差异。症状改善更大的预测因素包括女性、黑人、较少的医疗条件和在家庭医学诊所接受治疗。
在没有额外的系统支持或激励措施的情况下，简单地向初级保健临床医生反馈症状评分并不优于常规护理，无法改善症状结果。
clinicaltrials.gov 标识符：NCT02383862。
