Incorporating the patient’s voice: starting point for better care and outcomes

A few weeks ago, Ticbiomed officially welcomed summer with a webinar about PROMs and PREMs with Costaisa and María Antonia Maestre, from the Pharmacy Service at the Hospital of Manacor. 

Jordi Campo, Director of the Health Area at Costaisa, introduced María Antonia and provided a brief overview of the topic to be discussed. 

Let’s star with a PROMs and PREMs definition 

• PROMs (Patient Reported Outcome Measures) are questionnaires designed to measure outcomes reported by the patient.  

• PREMs (Patient Reported Experience Measures) are questionnaires used to evaluate the patient’s experience with the care they receive.  

Both are utilised to analyse and enhance the patient’s experience regarding treatment and care. 

Michael Porter: Value-Based Medicine 

The development and use of PROMs and PREMs are part of the “Value-Based Medicine” movement, as defined by Michael Porter. This well-known American economist applied key principles of business success to the healthcare sector and defined value as “the ratio of outcomes that truly matter to the patient to the total cost of their therapeutic process.” Additionally, he introduced new perspectives such as more holistic care, measuring outcomes with patient input, and bundled payments for services. 

This approach leads to more comprehensive patient care and empowerment, thereby improving the quality of care. 

How is this implemented? 

María Antonia explained in the webinar that nowadays we have very useful tools, namely the PROMs and PREMs questionnaires.   

For effective implementation, it is necessary to have a platform that automates the distribution of these questionnaires, simplifies their completion, and manages the collected information quickly, efficiently, and effectively. 

At the Hospital of Manacor, this automation began during the pandemic when Dr. Mercadal started sending questionnaires using Microsoft Forms. At that time, they already had Phemium as a telemedicine platform, and from the union of these two projects, Naveta was born. 

Naveta, in addition to managing PROMs and PREMs, includes features such as video calls, chat… It is a comprehensive and versatile tool designed and managed with input from a medical committee, engineers, and innovation experts. 

Indeed, “the centre’s aspiration is to create a community of professionals around the patient to share knowledge and protocols, thus getting closer to value-based medicine,” said María Antonia. 

Currently, Naveta has 8 clinical areas and 21 programmes, tailored to different pathologies. The next step, already in progress, is to include algorithms with sufficient and reliable information to provide answers to patients. Achieving this requires big data, which in turn requires networked collaboration to obtain the necessary data. 

Naveta in action 

The platform has a customisable dashboard that allows professionals to have a very comprehensive view of the patient’s overall state on a single screen and access the chat and information of all professionals assigned to each case, which the patient can also see. 

In terms of interaction with the patient, a feature that greatly speeds up care is the file exchange function, which both the patient and professionals can use to send photos (for instance of subcutaneous reactions), videos of applications, etc. The possibilities are endless. 

Sociodemographic, of habits and pharmacotherapeutic data 

A holistic view of the patient is key to ensure proper treatment. To this end, it is very useful to gather all the information we have about the patient in one place, from whether they smoke, their gender, employment status, to how often they exercise. 

This frequent interaction also gathers the patient’s perception of the quality of care received (PREMs), which is generally positive, thanks to the platform itself. 

Two real examples of the system’s effectiveness 

María Antonia shared with us the process and results of two real cases. In both cases, it was demonstrated that the exhaustive monitoring of the patient’s evolution allows for greater control, which is especially important in complex cases.

A clear example is the alert that a patient’s depressive state can signal the need to adjust medication or even replace some active ingredients. 

With Naveta, this can be done while continuing to monitor the progression of the disease, in this case, psoriasis. In addition, the exchange of photographs was very useful, even avoiding unnecessary trips to the health centre. 

Evidence supported by literature 

Multiple trials confirm the effectiveness of PROMs and PREMs in treating and monitoring patients. Some oncology studies show very positive data: less anxiety, fewer hospitalisations, fewer emergency visits, better quality of life, and even a better survival rate. 

Furthermore, configuring alerts for clinicians promotes early intervention in case of any anomaly. Reducing emergency visits, at the same time, eases pressure on these units. 

Challenges to consider 

Of course, implementing these tools also presents some challenges. Notably, the complexity of the system and issues related to the proper and safe collection and processing of data. 

Studies suggest solutions such as: 

• State-level leadership with cross-institutional support. 

• Digitalisation of the healthcare system. 

• Providing adequate training and support, not only for the system and healthcare professionals but also for patients and society as a whole. 

In light of these considerations, María Antonia highlighted the need for a structured method to implement changes and improvements, as well as to incentivise proactivity in effectively adopting tools. 

The expert´s opinion 

“My perception is that we must leverage the available tools so that the scarcity of human resources we face does not lead to poorer care and patient follow-up. 

Additionally, we need to understand these patients, such as their maturity in using technology, to adapt proposals to each one as much as possible and make them effective.  

And then, we must always remember that we are dealing with extremely sensitive data. The information obtained can be very useful. A simple example is setting a frequency of appointments tailored to each need, which also results in a more effective allocation of healthcare resources. But this data must be handled with utmost security,” added María Antonia. 

Continuous monitoring and improvement 

Constant evaluation is the only way to keep improving. PROMs and PREMs allow for very close monitoring of each patient. Additionally, on a global level, mass data processing to obtain statistics and results opens the door to significant advancements in understanding each disease and the decisions associated with it. 

We can summarise the multiple areas of impact of PROMs and PREMs in a single image: 

 

 

 

 

 

 

 

 

 

 

 

 

In the webinar’s question-and-answer session, several crucial points were clarified. 

How to encourage patient participation is one of the main challenges in implementing these systems, but María Antonia pointed out two solutions that work very well for her. First, showing them in person the relationship between their cooperation and their positive progress by turning the screen during the consultation and explaining point by point what they see, if necessary. 

Secondly, close follow-up is essential. For this, it is very useful to automate alerts, always keeping in mind that the patient can respond at their convenience. Sometimes, answering certain questions means connecting with the illness, and everyone has their own time to do so. 

At this point, Jordi added that gradually sending information and questions can also help to avoid overwhelming the patient. 

Moreover, it is important to involve the entire team of professionals, so everyone contributes to motivating the patient to complete the questionnaires. 

Not all technologies are for everyone 

Not everyone has the same attitude towards change or technology, and certainly not everyone is at the same level of digital maturity, whether professionals or patients. We should take advantage of those who are most inclined to initiate changes and set an example. 

Speaking about the resistance that more innovative profiles sometimes encounter within the medical community, which could be heightened by certain concerns such as data protection, María Antonia clarified that these doubts are usually more institutional, to avoid problems, than from the patients themselves, who generally do not have issues with sharing information. 

The crucial role of nurses 

María Antonia concluded the webinar by acknowledging the crucial role of nursing professionals in these transformations. They are transversal profiles, in contact with all areas, and have a great potential for impact. 

  

WATCH WEBINAR  (Spanish)

 

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Costaisa is a company specialising in healthcare that has been offering consulting services and business solutions based on information technology for over 55 years. Their wide range of products makes them leaders in covering various IT needs of any healthcare organisation. The company also has a multidisciplinary team of highly qualified professionals with extensive experience in national and international projects. They have been member of Ticbiomed association for many years.