Core Patient-Reported Outcomes (PROs) and PRO Measures (PROMs) for polypharmacy Medicines Reviews: A Sequential Mixed-Methods Study

Kotronoulas, G. , Cooper, M. and Johnston, B. (2019) Core Patient-Reported Outcomes (PROs) and PRO Measures (PROMs) for polypharmacy Medicines Reviews: A Sequential Mixed-Methods Study. Patient Preference and Adherence, 13, pp. 2071-2087. (doi: 10.2147/PPA.S236122)

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Purpose: Problematic polypharmacy can exaggerate “medicine burden” for the patient. Patient-reported outcomes (PROs) are key indicators of medicine burden, and PRO measures (PROMs) can help patients articulate their perceptions of medicine burden. We aimed to: (a) evaluate what PROMs currently exist that assess medicine burden, and what PROs they target, and (b) understand patients’ experiences with using multiple medicines to establish a core set of most meaningful and relevant PROs for assessment in polypharmacy medicines reviews. Patients and Methods: We conducted a prospective, sequential mixed-methods study in two consecutive work phases. Phase 1 involved a rapid review of PROMs, informed by the published PRISMA and COSMIN initiative guidelines. We integrated all evidence in a thematic narrative synthesis. Phase 2 involved cross-sectional, one-to-one, semi-structured interviews with key stakeholders, including members of the public and healthcare professionals (HCPs). We conducted thematic content analysis to identify and classify emerging PROs. Results: In Phase 1, 13 studies described the development and/or validation of 12 PROMs. The PROMs targeted 14 content domains of adult patients’ experiences with prescribed medicines. PROMs varied widely in terms of length, comprehensiveness and psychometric robustness. In Phase 2, all participants (seven members of the public; eight HCPs) agreed on the clinical relevance of PROMs, providing a rich account of justifications. We identified four core PROs: ‘Knowledge, information and communication about own medicines’; “Perceptions, views and attitudes about (own) medicines”; “Impact on daily living: Side-effects and practicalities”, and “Medicine usage: ‘as planned’, misuse, abuse, no use”. Conclusion: We suggest combining psychometrically robust PROMs or domains across PROMs into a bespoke PROM that addresses comprehensively and succinctly the four core PROs. We recommend a careful implementation process that must involve consultation with all relevant stakeholders, while establishing a clear purpose for collecting a PROM and realistic and ongoing collection at key time-points.

Item Type:Articles
Additional Information:Funding: Scottish Government Effective Prescribing and Therapeutics Division
Glasgow Author(s) Enlighten ID:Cooper, Dr Mark and Kotronoulas, Dr Greg and Johnston, Professor Bridget
Authors: Kotronoulas, G., Cooper, M., and Johnston, B.
College/School:College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Nursing and Health Care
Journal Name:Patient Preference and Adherence
Publisher:Dove Medical Press
ISSN (Online):1177-889X
Copyright Holders:Copyright © 2019 The Authors
First Published:First published in Patient Preference and Adherence 13:2071
Publisher Policy:Reproduced under a Creative Commons License

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