Accepted for/Published in: JMIR Formative Research
Date Submitted: Mar 2, 2021
Date Accepted: Aug 24, 2021
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Feasibility and Acceptability of a Digital Patient Reported Outcomes (PRO) Tool in Routine Outpatient Diabetes Care: A Mixed-Method Formative Pilot Study
ABSTRACT
Background:
Improvements in digital health capabilities of health systems provide new opportunities for integration of Patient-Reported Outcome (PRO) solutions in routine care which can facilitate the delivery of person-centered diabetes care. We undertook this study as part of our development of a new digital PRO diabetes questionnaire and clinical dialogue support tool for use by people with diabetes (PWD) and their health care professionals (HCP) in order to improve person-centered diabetes care quality and outcomes.
Objective:
This formative pilot study aimed to evaluate feasibility, acceptability, and perceived benefits and impacts of use of a digital PRO diabetes tool, DiaProfil, in routine outpatient diabetes care.
Methods:
Twelve PWD scheduled for routine medical diabetes visits at the outpatient clinic were recruited. Purposive sampling was used to optimize heterogeneity regarding age, gender, duration, type of diabetes, treatment modality, and disease severity. Participants filled out a PRO diabetes questionnaire 2-5 days prior to their visit. During the visit, the HCP used a digital PRO tool to display the PRO data with the PWD for collaborative care planning. Participants completed evaluation forms before and after the visit and all PWD were interviewed for 30-45 minutes after the visit. HCP completed evaluation questionnaires after each visit. All visits were audio-recorded and transcribed for analysis. Data was analyzed using quantitative, qualitative, and mixed-methods analysis methods.
Results:
PWD experienced the PRO diabetes questionnaire was relevant, acceptable, and feasible to complete from home. Both PWD and HCP found the digital PRO tool to be feasible and acceptable for use during the diabetes visit and would like to continue using it. HCP were able to use the tool in a person-centered way as intended. For some PWD, completion of the questionnaire facilitated positive reflection and better preparation for the visit. The use of the PRO tool primarily improved the quality of the dialogue by improving identification and discussion of the PWD’s key issues. PWD did not report any negative aspects of the PRO tool whereas HCP highlighted that it was a challenge for them when the PWD had many PRO issues that required attention within the pre-defined time allocated for a visit.
Conclusions:
The national Danish PRO diabetes questionnaire and the digital tool, DiaProfil is a feasible and acceptable solution for routine diabetes visits and the tool may generate important benefits related to advancement of person-centered care. Further research is now required to corroborate and expand these formative insights in a larger scale and in diverse healthcare settings. The results of this study are therefore being used to define research hypotheses and finalize real-world PRO evaluation questionnaires and data collection tools for a forthcoming large-scale multi-sector implementation study in Denmark. Clinical Trial: DiaProfileProtocol1ABC
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