Outcomes Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9169 Medical Center Drive, Rockville, MD, 20850, USA.
Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA.
BMC Prim Care. 2024 Mar 1;25(1):77. doi: 10.1186/s12875-024-02316-5.
The aim of this study was to develop a web-based tool for patients with multiple chronic conditions (MCC) to communicate concerns about treatment burden to their healthcare providers.
Patients and providers from primary-care clinics participated. We conducted focus groups to identify content for a prototype clinical tool to screen for treatment burden by reviewing domains and items from a previously validated measure, the Patient Experience with Treatment and Self-management (PETS). Following review of the prototype, a quasi-experimental pilot study determined acceptability of using the tool in clinical practice. The study protocol was modified to accommodate limitations due to the Covid-19 pandemic.
Fifteen patients with MCC and 18 providers participated in focus groups to review existing PETS content. The pilot tool (named PETS-Now) consisted of eight domains (Living Healthy, Health Costs, Monitoring Health, Medicine, Personal Relationships, Getting Healthcare, Health Information, and Medical Equipment) with each domain represented by a checklist of potential concerns. Administrative burden was minimized by limiting patients to selection of one domain. To test acceptability, 17 primary-care providers first saw 92 patients under standard care (control) conditions followed by another 90 patients using the PETS-Now tool (intervention). Each treatment burden domain was selected at least once by patients in the intervention. No significant differences were observed in overall care quality between patients in the control and intervention conditions with mean care quality rated high in both groups (9.3 and 9.2, respectively, out of 10). There were no differences in provider impressions of patient encounters under the two conditions with providers reporting that patient concerns were addressed in 95% of the visits in both conditions. Most intervention group patients (94%) found that the PETS-Now was easy to use and helped focus the conversation with the provider on their biggest concern (98%). Most providers (81%) felt they had learned something new about the patient from the PETS-Now.
The PETS-Now holds promise for quickly screening and monitoring treatment burden in people with MCC and may provide information for care planning. While acceptable to patients and clinicians, integration of information into the electronic medical record should be prioritized.
本研究旨在开发一种基于网络的工具，供患有多种慢性疾病（MCC）的患者与医疗保健提供者交流有关治疗负担的问题。
来自初级保健诊所的患者和医务人员参与了研究。我们通过审查先前验证过的患者治疗和自我管理体验（PETS）测量工具中的领域和项目，开展了焦点小组讨论，以确定用于筛查治疗负担的原型临床工具的内容。在对原型进行审查后，一项准实验性试点研究确定了在临床实践中使用该工具的可接受性。由于 COVID-19 大流行，研究方案进行了修改以适应限制。
15 名 MCC 患者和 18 名医务人员参加了焦点小组，以审查现有 PETS 内容。该试点工具（命名为 PETS-Now）由八个领域组成（健康生活、健康成本、健康监测、药物、人际关系、获得医疗保健、健康信息和医疗设备），每个领域都用潜在关注问题清单表示。通过限制患者仅选择一个领域，最大限度地减少了行政负担。为了测试可接受性，17 名初级保健提供者首先在标准护理（对照）条件下为 92 名患者提供服务，然后在干预条件下使用 PETS-Now 工具为另外 90 名患者提供服务。干预组患者至少选择了一个治疗负担领域。在对照和干预条件下，患者的整体护理质量没有显著差异，两组的护理质量评分均较高（分别为 9.3 和 9.2，满分 10 分）。两种情况下，提供者对患者就诊的印象没有差异，提供者报告在两种情况下 95%的就诊中都解决了患者的问题。大多数干预组患者（94%）认为 PETS-Now 使用方便，有助于将与提供者的对话重点放在他们最大的问题上（98%）。大多数提供者（81%）认为他们从 PETS-Now 中学到了有关患者的新知识。
PETS-Now 有望快速筛查和监测 MCC 患者的治疗负担，并为护理计划提供信息。虽然患者和临床医生都可以接受，但应优先将信息纳入电子病历。
