In a recent interview with PharmaShots, Duncan Short, Ph.D., Director of Global Implementation Science at ViiV Healthcare shared his views on the findings of a new study demonstrating how the inclusion of a brief survey focused on patient-reported outcomes (PROs) during doctor's appointments can improve HIV care.

Shots:

• In the study, people living with HIV were provided with a pre-visit survey to guide their conversation with their HCP and assess PROs covering a range of measures, including treatment adherence, mental health, substance abuse, and intimate partner violence

• According to 200 patient participants, the inclusion of the pre-visit survey made their visit better overall (82%), reminded them of health concerns to raise (81%), and helped them discuss issues that were difficult to speak frankly about (71%)

• 82% of surveyed HCPs agreed the pre-visit survey added value to the visit, made the consultation better, and led to more discussions on potentially sensitive topics

Tuba: How did the inclusion of a brief survey focused on PROs during doctor's appointments improve HIV care?

Duncan: The results of the PROgress study showed that a brief pre-visit patient survey asking questions about a range of issues, including mental health, life circumstances, and health related behaviours can help improve HIV care by making these more likely to be raised, discussed and potentially acted upon by their doctor.

Participants in the study said it can be challenging to go into a doctor's visit and initiate discussions about several issues that aren't observable to those providing care, and aren't always raised. Some find it difficult to disclose certain things in person, even if they have known their doctor for a long time or have a good relationship.

The findings of PROgress are important because they show how a simple survey before an appointment, can help patients be more open about their needs, behaviours and preferences which helps both the individual and their doctor ensure they receive the best care and support.

Tuba: Discuss the design of PROGRESS study i.e., study site, duration of the study, number of patients, etc.

Duncan: The PROgress site study was conducted over approximately 15 months at two North American community-based HIV outpatient clinics (St. Michael's Hospital, Toronto, ON and Midway Specialty Care Clinic, Ft. Pierce, FL) and assessed the implementation and value of patient reported outcomes within routine care, from the perspectives of people living with HIV, doctors and clinic staff.

During the study, 1761 brief electronic tablet survey sessions were initiated for people living with HIV to self-administer after arriving at their clinic visit. Each survey took on average nine minutes to complete and assessed patient reported outcomes covering a range of measures, including treatment adherence, depression, suicide ideation, anxiety, substance use, and intimate partner violence. The results of the survey were instantly made available in a summary format to the healthcare provider for use during the appointment discussion.

The evaluation included information from the PRO platform, 597 chart reviews, 234 questionnaires and 47 qualitative interviews with a combination of patients, doctors and other clinic staff.

Tuba: Please showcase the key findings of PROGRESS study.

Duncan: The PROgress study found that the pre-visit survey improved providers awareness of patient needs, behaviours and issues that may be otherwise hidden, including sensitive or difficult to raise topics.  People living with HIV found the survey improved communication with their healthcare provider by helping prioritize discussion topics, helping initiate discussion on sensitive issues, and improving comprehensiveness of and satisfaction with care. Healthcare providers found the pre-visit assessment to be valuable for understanding patients needs and could be incorporated into routine care with minimal disruption to clinic flow. Any additional impact upon their workload relating to individual patients was regarded as a valuable tradeoff.  

Tuba: What are the perspectives of healthcare providers on conducting a pre-visit survey?

Duncan: Providers found the pre-visit survey valuable and acceptable within clinical practice. 82% of healthcare providers agreed or strongly agreed that the inclusion of the survey added value to the visit overall, made the consultation easier, helped prioritize discussion topics with patients, identified topics that would not have been addressed, and led to more discussions on potentially sensitive topics.

45% of healthcare providers agreed that the pre-visit survey saved time during their consultation, and only 27% disagreed. Furthermore, one-on-one interviews revealed that in instances where the pre-visit survey findings impacted workflow, healthcare providers noted it was manageable and worth the tradeoff for the ability to better identify issues and address sensitive issues that may otherwise have been missed.

Tuba: Can you discuss the resources made available to help implement patient reported outcomes from PROgress into clinical practice?

Duncan: In addition to the initial published findings of the PROgress study evaluation, the PROgress Implementation Toolkit and other supporting resources available at https://progresshivcare.org/ for those interested in adopting PROs into their clinic practice. The toolkit provides practical information to support decision making from preparation to implementation and monitoring. The website also hosts the PROgress Evidence Review and Summary, to raise awareness of published literature regarding the impact of PROs in routine clinical care.

Tuba: What other studies are a part of ViiV's Implementation Science Program?

Duncan: The PROgress study and other research initiatives currently underway are part of ViiV Healthcare's new and growing Implementation Science program, which focuses on improving the real-world delivery of HIV treatment and care outside the structured environment of clinical trials.

ViiV Healthcare's Implementation Science efforts have the goal of identifying what works best, where it works, why it works, and how these findings can be best applied to improve lives. Through its Implementation Science efforts, ViiV Healthcare is committed to improving everything from access to testing and treatment to finding ways to make it easier for people living with HIV to take their medicines regularly.

About Author:

Duncan Short is the Director of Global Implementation Science at ViiV Healthcare. He focused on global projects that seek to bridge the gap between research and real-world practice, by studying interventions and implementation strategies within HIV care.

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