Core Patient-Reported Outcomes (PROs) and PRO Measures (PROMs) for Polypharmacy Medicines Reviews: A Sequential Mixed-Methods Study
Received 25 October 2019
Accepted for publication 3 December 2019
Published 13 December 2019 Volume 2019:13 Pages 2071—2087
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Johnny Chen
Grigorios Kotronoulas,1 Mark Cooper,1,2 Bridget Johnston1,2
1School of Medicine, Dentistry & Nursing, College of Medicine, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK; 2NHS Greater Glasgow and Clyde, Glasgow, UK
Correspondence: Grigorios Kotronoulas
School of Medicine, Dentistry & Nursing, College of Medicine, Veterinary & Life Sciences, University of Glasgow, 57-61 Oakfield Avenue, Glasgow G12 8LL, United Kingdom
Tel +44 141 330 6883
Purpose: Problematic polypharmacy can exaggerate “medicine burden” for the patient. Patient-reported outcomes (PROs) are key indicators of medicine burden, and PRO measures (PROMs) can help patients articulate their perceptions of medicine burden. We aimed to: (a) evaluate what PROMs currently exist that assess medicine burden, and what PROs they target, and (b) understand patients’ experiences with using multiple medicines to establish a core set of most meaningful and relevant PROs for assessment in polypharmacy medicines reviews.
Patients and Methods: We conducted a prospective, sequential mixed-methods study in two consecutive work phases. Phase 1 involved a rapid review of PROMs, informed by the published PRISMA and COSMIN initiative guidelines. We integrated all evidence in a thematic narrative synthesis. Phase 2 involved cross-sectional, one-to-one, semi-structured interviews with key stakeholders, including members of the public and healthcare professionals (HCPs). We conducted thematic content analysis to identify and classify emerging PROs.
Results: In Phase 1, 13 studies described the development and/or validation of 12 PROMs. The PROMs targeted 14 content domains of adult patients’ experiences with prescribed medicines. PROMs varied widely in terms of length, comprehensiveness and psychometric robustness. In Phase 2, all participants (seven members of the public; eight HCPs) agreed on the clinical relevance of PROMs, providing a rich account of justifications. We identified four core PROs: ‘Knowledge, information and communication about own medicines’; “Perceptions, views and attitudes about (own) medicines”; “Impact on daily living: Side-effects and practicalities”, and “Medicine usage: ‘as planned’, misuse, abuse, no use”.
Conclusion: We suggest combining psychometrically robust PROMs or domains across PROMs into a bespoke PROM that addresses comprehensively and succinctly the four core PROs. We recommend a careful implementation process that must involve consultation with all relevant stakeholders, while establishing a clear purpose for collecting a PROM and realistic and ongoing collection at key time-points.
Keywords: medication experiences, preferences, knowledge, perceptions, impact on daily living, monitoring
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