Helping healthcare providers help HIV-positive patients…
The PROgress project “Improving HIV Care Through the Implementation of Patient Reported Outcomes Within Routine Patient Management” is a ViiV Healthcare-sponsored program that was initially implemented at St. Michael’s Hospital in Toronto to help improve care at HIV outpatient clinics. To find out more, we spoke with Jean Bacon, executive director of the Ontario HIV Treatment Network, and Alexandra Musten, the senior lead, testing and clinical care initiatives at the Ontario HIV Treatment Network. Here’s what they had to say.
Tell us more about PROgress. How did the project come to be and how does it work?
We first heard about the potential for Patient Reported Outcomes [PROs] to improve patient care when Heidi Crane from the University of Washington presented on the system they had implemented in their HIV clinic at a conference organized by the International Association of Providers of AIDS Care (IAPAC). We were excited about the possibility of replicating the system in Ontario, so when we had the opportunity to join ViiV’s PROgress study, we jumped at it.
For us, it was a unique opportunity to implement the PRO in a couple of HIV clinics in Ontario, demonstrate its impact, and then scale it to other clinics across the province. We see it as a highly effective way for patients to communicate with their providers, and for providers to be aware of a range of issues that might not come up during an appointment.
What need does this project serve? And what are the main benefits of the project for healthcare providers and patients?
This project addresses the challenge we all face with having too much to discuss and not enough time with providers. And providers feel this as well. PROgress is a computer-based survey that includes a number of questionnaires that cover a range of issues including nutrition, housing, medication adherence, mental health issues and substance use. Patients complete the survey, and a report is produced and sent to the provider before they begin the clinic visit. The provider uses this report to help focus discussion.
How does this tool strengthen the care provider-patient relationship?
PROs not only help to prioritize issues, they also help identify some issues in the first place. Studies have found that patients tend to answer questions on the tablet more honestly than if they were asked in person. Providers often learn key things they had not known about their patient that may change the focus of their care or lead to better referrals. If the patient identifies an issue on the PRO, the provider can ask about it right away and start the conversation.
How can healthcare professionals utilize this tool or implement a similar practice?
Our hope is that healthcare providers will see PRO as an effective way to measure and monitor patient wellness. PROs have great potential to help consolidate a large amount of information on a patient’s physical, mental and social well-being in advance so providers can act on this information in real time. With the drastic increase in telemedicine due to COVID restrictions, we see great potential for PROs to be used as part of wellness checks. To support this, we’re moving PROs off the tablet at the clinic and sending them as a secure unique URL for patients to complete at home.
We would encourage any clinic that isn’t able to implement PROs to think about questions they might not be asking. Mental health is top of mind, especially after these lengthy lockdowns and periods of isolation. When difficult questions are asked with compassion, patients are grateful for the opportunity to discuss them.
How does this tool fit into conversations about stigma, treatment optimization and prevention?
PROs can be an important part of discussions about treatment optimization and prevention. It asks patients about how well they are adhering to their medications, and patients are more likely to acknowledge if they are missing doses. If they are, that creates an opportunity for the provider to reinforce that adherence is important – both for the patient’s health and to prevent onward transmission – and for the provider and patient to discuss factors that may be affecting adherence, and develop strategies to overcome them.
We are about to implement PROgress in a primary care clinic where all patients – not just the ones with HIV – will complete the survey. In that case, the PROs will help providers identify people at high risk of acquiring HIV and offer them PrEP.
In the long term, can this tool help to improve the patient’s choice around their health?
Long term, we really hope that this tool will allow clinics to collect accurate information that helps providers talk more openly with patients about any issues they face and how to manage them, and that helps patients make more informed decisions about their health and health care. The more patients and providers talk together about health issues, the more empowered the patient will be.
For more information on PROgress, visit https://progresshivcare.org.