Use of Patient-Reported Outcome Measures in Patients with Rheumatoid Arthritis in Spain and Barriers to Implementation: A Delphi Study

Abstract

INTRODUCTION: This study aimed to investigate the pattern of use and barriers for implementation of patient-reported outcomes measures (PROMs) in patients with rheumatoid arthritis (RA) in Spain. METHODS: Two-round Delphi study targeted at rheumatologists attending a PROMs training program and guided by a Scientific Committee composed of four expert rheumatologists was conducted. The survey assessed the current use, appropriateness, and feasibility of 7 PROMs proposed by the International Consortium for Health Outcomes Measurements (ICHOM). Barriers to implement PROMs in routine care were also explored. A 7-point Likert scale was used ranging from 1 (strongly disagree) to 7 (strongly agree). Consensus was established when > 75% reached agreement (rated 6-7 = agreement, or 1-2 = disagreement). RESULTS: A total of 39 rheumatologists of 120 (32%) participated {61.5% women; mean age 50.3 [standard deviation (SD) 11.0] years; mean 18.1 (9.6) years of experience; 23.1% running a RA clinic}. Although 82.1% of rheumatologists agreed on involving patients in shared decision-making (SDM), only 56.4% adopted SDM strategies in treatment decisions. A higher percentage (79.4%) agreed on the importance of incorporating PROMs, but only 28.2% recognized to use them in routine care, being the most frequently used pain on a visual analogue scale (VAS) (89.8%), the Health Assessment Questionnaire (HAQ) (71.7%), and a VAS-fatigue (66.7%). The remaining proposed PROMs by ICHOM did not reach a consensus on either appropriateness or feasibility. The main barriers found included lack of time in consultation (84.6%) and the unavailability of PROMs platforms incorporated in the electronic medical records (87.9%). CONCLUSION: Spanish rheumatologists consider PROMs useful to guide SDM in routine care being the most frequently used pain, fatigue, and physical function. However, other domains proposed by ICHOM as health-related quality of life (HRQoL) or work/school productivity are not commonly used. Promoting the use of PROMs strategies, including optimizing consultation time and incorporating PROMs into electronic medical records, is necessary.