Chiropractic Australia Journal Club

By: Dr Andrew Shepherd BSC Chiro Sc, M Chiropractic

Chiropractic Australia Journal Club

This edition we will be exploring the use of technology in using patient reported outcome measures (PROMs) in clinical practice and is based on the recent paper titled “PROMs data: can it be used to make decisions for individual patients? A narrative review” by Jonathon Field, Michelle M Holmes and Dave Newell (2019).

This paper discusses the current use of PROMs and its growing importance in both health care research and private clinical practice in providing data on the patient’s perspective of their health and care. Traditionally these validated outcome measures have been used in clinical practice for predicting the course of a disease, the efficacy of treatment and care quality.

Although very useful, Field et al describe the main issue with PROMs in clinical practice being their infrequent use by clinicians as part of their interaction with their patients either due to time constraints due to the higher administrative workload involved in using PROMs or not having the necessary knowledge to implement them.

PROMs have utility to establish baselines and as a screening tool for patients along with tracking progress in care at different points in the course of their treatment. However, the authors propose that PROMs could be used for every clinical encounter as a routine assessment and tracking tool.

PROM data has become increasingly useful in providing information about aspects of a patient’s health and care that are specifically important to the actual patient. This in turn can drive the decisions clinicians can make on a course of care and catering to all three facets of the biopsychosocial model of evidence-based practice.

By being more able to track the psychosocial aspects of patient care, PROMs can also inform the practitioner on when to refer, enhancing collaborative care with other allied health and medical practitioners. It also improves the patient-practitioner relationship by using the PROM to keep both parties on the same page as a partnership, as well as empowering the patient to engage more in their own care outside of the clinical encounter.

In the past as well as present, PROMs have been measured by pen and paper questionnaires filled out by the patient and scored and recorded by the practitioner. This can be seen as too time consuming and tedious by some patients and practitioners. However, with recent innovations in technology and the rise of the E-PROM or electronic PROM, these questionnaires are becoming more user friendly and efficient, demonstrated by the authors own E-PROM, Care Response (https://support.care-response.com/).

Given that smart phone and other electronic device ownership has risen dramatically over the past few years, the use of bespoke apps and web applications are becoming more practical for clinical practice. These E-PROMs need to be simple for both the clinician and the patient to use and clinicians need some training as well as collaboration with their patient as to what E-PROM is appropriate for the needs of the patient at the time of presentation.

In order to make E-PROMs a part of everyday practice it may be necessary to develop algorithms based on data from the patient’s initial history on intake in order to decide which E-PROMs are appropriate for initial assessment, establishment of baseline data and ongoing progress tracking.

Cloud-based web applications are useful as they can be accessed from any device that can connect to the cloud. These applications could provide ongoing PROM data by allowing both the practitioner and the patient to access it from anywhere in real time and make the process part of a clinicians ongoing clinical note taking, effectively integrating traditional SOAP notes with E-PROMs. If this method could be standardised it could mean that clinical note taking, and PROM use becomes more consistent between practitioners and professions.

In addition, if the daily use of E-PROMs integrated with clinical note taking can capture large amounts of data in the way that Care Response does then this provides a wealth of data that, if de-identified and exported safely to a university database, can be used for research.

As far as chiropractic is concerned, there is still some catching up to do in terms of research to validate our place in health care. If technology can combine efficient note taking and PROM tracking along with important data capture for research, it presents a tremendous win/win opportunity for the profession.