HIV Patient-Reported Outcomes Improve Patient Care
Presenter: Paul Parisot, III, MD, Resident Physician, Vanderbilt University Medical Center, Nashville, Tennessee
A summary of Patient Reported Outcomes Collection: A Mixed Methods Study at an Urban HIV Clinic Associated with A Historically Black Medical College in the Southern United States, September 29, 2021
Collection of patient-reported outcomes (PROs) data allows clinicians to screen vulnerable HIV patients for social and behavioral determinants of health. To be impactful, PROs must be clinically relevant, accessible to patient and provider, and integrated in clinic workflow. According to Paul Parisot, III, MD, Resident Physician, Vanderbilt University Medical Center, Nashville, Tennessee, studies have shown that collection of PROs can improve patient outcomes and provide often-overlooked data on mental health, substance use, and patient adherence to antiretroviral therapy.
“We piloted the use of an electronic tablet to collect PRO data on social and behavioral determinants of health among people living with HIV (PLWH),” said Paul Parisot, III, MD. Parisot and colleagues collected data using the Research Electronic Data Capture (REDCap) platform on a hand-held tablet at the Meharry Community Wellness Center, an HIV clinic affiliated with an historically Black medical college in Nashville, Tennessee. Black Americans, particularly those living in the south, are disproportionately impacted by the US HIV epidemic.
One hundred consecutive patients were enrolled. Using a purposive sampling strategy, 20 of the 100 participants underwent an in-depth interview, grounded in the Cognitive Behavioral Model in which thoughts, feelings, and behaviors are interrelated. Interviews were audio-recorded, transcribed, de-identified, and formatted for coding. A hierarchical coding system was developed and refined using an inductive-deductive approach.
Among 100 PLWH enrolled, median age was 50 years, 60% were male, the vast majority (89%) were Black, and most (82%) were living below 100% of the federal poverty level. Nearly three-quarters (71%) had stable or permanent housing. HIV transmission was mainly owing to heterosexual contact (59%), male-to-male sexual contact (22%), or injection drug use (14%).
“Participants felt the tablet was easy to use and question content was meaningful. Question content related to trauma, sexual and drug use behaviors, mental health, stigma, and discrimination elicited uncomfortable or distressing feelings in some participants,” said Parisot.
“Patients expressed a strong desire to be truthful, and most would complete these surveys without compensation at future visits if offered,” continued Parisot.
Parisot noted in conclusion that use of an electronic tablet to collect PROs was feasible and well received. Despite some discomfort with personal questions, participants felt the questions were important and could improve patient-provider relationships.
According to Parisot, future research is warranted to further assess the impact of PRO collection on workflow in a routine clinic setting, elicit feedback from clinic providers on PRO utility, evaluate response rates in a non-incentivized setting, and correlate PROs and HIV continuum of care outcomes.
Disclosures
Paul Parisot, III, MD: Nothing to disclose.
References
Parisot P, Wheeler F, Bonnett K, et al. Patient reported outcomes collection: a mixed method study at an urban HIV clinic associated with a historically Black medical college in the southern United States. Presented virtually at: 10th Annual IDWeek 2021; September 29, 2021. Abstract 51.