How Standardising the Doctor-Patient Consultation Could Improve Health Care

So says University of Sydney Professor Madeleine King, who is investigating how to successfully implement the use of Patient Reported Measures (PRMs) in a way that will inform and guide clinicians in real time when treating patients.

Professor King says that the goal of using patient feedback is a key element in the philosophy of patient-centred care but, despite being proposed in heath circles for more than two decades, it is only now that the tools and technology to effectively do it are becoming available.

“For a very long time in health care there has been a lot of conversation about this but there hasn’t really been enough effective action,” said Professor King.

“What’s changed recently is that we’ve become much better at designing patient surveys to capture their feedback and also better at designing the IT systems required to properly use that data. Now PRMs could finally be the lever that we need to make healthcare truly patient-centred.”

In collaboration with the NSW Agency for Clinical Innovation Patient Reported Measures team, and with the assistance of a grant from Sydney Health Partners, Professor King and colleagues at the University of Sydney Quality of Life (QOL) Office have been trying to identify what exactly are the barriers and facilitators to implementing PRMs in hospitals.

An analysis of de-identified qualitative data provided by the ACI and a review of existing research literature concluded that there is no consensus about the barriers and facilitators to implementation.

“The literature review was equivocal and highlighted gaps in our knowledge,” said Dr Claudia Rutherford, Deputy Director to Professor King at the QOL Office. “It pointed to the requirement for context-specific qualitative research of clinicians’ attitudes within the Sydney Health Partnership area, which we hope to undertake soon.”

ACI and e Health NSW have procured an IT platform and are now customising it for the broader NSW Health context to allow clinicians to access reports on PRMs in real-time, so that a clinician can see in a snapshot of whether or not the patient reports feeling better.

“Anecdotally, one of the biggest barriers to using PRMs which we hear from clinicians is ‘oh it’s just another thing I have to do and I’m already time poor’ ”said Professor King. “But we believe that if done properly, accessing and reviewing patient reported measures from a PRM IT system shouldn’t take clinicians any more time than talking to their patients does now. Rather it will focus the available time on the issues that matter to patients, making the clinical consultation more efficient and patient-centred.”

Dr Rutherford says the PRM IT platform will standardise the questions doctors are asking their patients.  For example, patients will be asked to numerically rank their level of pain, tiredness, ability to perform work or tasks, as well as a number of other symptoms related to their specific health condition(s).

Over time or when compared to the population average, this data will tell clinicians whether how the patient feels s/he is tracking and highlight when further investigator or action may be required.

“Clinicians are already asking these sorts of questions of their patients but PRM surveys allows that information to be gathered in a standardised way,” said Dr Rutherford.

“Some clinicians currently do that really well, others not so well, so this is just a tool, a checklist to prompt a conversation. Importantly though, what it does is to prioritise consultation time around the issues the patient is wanting to focus on and matters most to them.   

“This should help make care more patient-centred, and it may in turn improve quality of care and patient satisfaction with care. That’s the end game.”