JMIR Publications

ABSTRACT

Background:

Persons with multiple chronic conditions face complex medical regimens, and clinicians may not focus on what matters most to these patients who vary widely in their health priorities. Patient Priorities Care is a facilitator-led process designed to identify patients’ priorities and align decision making and care, but the need for a facilitator has limited its widespread adoption.

Objective:

Design and test mechanisms for patients to complete a self-directed process for identifying priorities and providing their priorities to clinicians.

Methods:

The study involved patients > 65 years old at 2 family medicine practices with 5 physicians each. We first tested 2 versions of an interactive website and asked patients to bring their results to their visit. We then tested an Epic pre-visit questionnaire derived from the website’s questions and included with standard pre-visit materials. We completed post-intervention phone interviews and an online survey with participating patients and collected informal feedback and conducted a focus group with participating physicians.

Results:

In the test of the first website version, 17.3% (35/202) of invited patients went to the website, 11.4% (23/202) completed all of the questions, 2.5% (5/202) brought results to their visits, and the median session time was 43.0 minutes, IQR=28.0 minutes. Patients expressed confusion about bringing results to the visit. After clarifying that issue in the second version, 15.1% (32/212) of patients went to the website, 14.6% (31/212) completed the questions, 1.9% (4/212) brought results to the visit, and the median session time was 35.0 minutes, IQR=35.0 minutes. In the test of the Epic questionnaire, 26.4% (198/750) of patients completed the questionnaire before at least 1 visit, and median completion time was 14.0 minutes, IQR=23.0 minutes. The 8 main questions were answered 62.9-95.6% of the time. Patients who completed questionnaires were younger than those who did not (72.3 vs 76.1 years) and completed more (98.5%) of other assigned questionnaires than those who did not (2.3%). 140 of 198 patients (70.7%) responded to a survey, and 86 remembered completing the questionnaire; 78 (90.7%) did not remember having difficulty answering the questions, and 57 (68.7%) agreed or somewhat agreed that it helped them and their clinicians understand their priorities. Doctors noted that the sickest patients did not complete the questionnaire, and that discussion provided a good segue into end-of-life care.

Conclusions:

Imbedding questionnaires assaying patient priorities into patient portals holds promise for expanding access to priorities concordant care. Clinical Trial: none