Journal Article

PMO-19 Barriers and facilitators to clinical activity indices for IBD in routine practice: a qualitative study

Young, Bridget, Williamson, Paula, Razanskaite, Violeta, Bodger, Keith

2021

Overview

IntroductionA recent national audit of biological therapies in the UK suggested that the recording of a disease activity index (Harvey-Bradshaw Index or Simple Colitis Activity index) was uncommon in routine settings.1 Our aims were to explore the barriers and facilitators to the use of clinical instruments in hospital-based inflammatory bowel disease (IBD) outpatient services, and the reasons for lack of standardisation in outcome assessment by practitioners.MethodsWe performed structured observations of real-life consultations conducted with 102 patients by 24 clinicians (14 doctors and 10 specialist nurses) at six hospitals across the North West region of England, followed by 24 qualitative semi-structured interviews with observed IBD practitioners. Qualitative data analysis was iterative and drew on thematic approaches to describe observed and self-reported practices, views and preferences.ResultsDuring observed consultations, most clinicians performed personalised assessments of symptoms instead of using a standardised clinical index, and expressed preferences for individualised patient-centred evaluations of health status as opposed to a standardised approach. Practitioners captured indices in only 15% of observed consultations and stated that standardised tools were collected primarily for secondary uses of data and seen as an administrative burden with little relevance to clinical context. The perceived barriers to routine use of indices were 1) lack of application in individual decision making due to weak psychometric properties and poor specificity for inflammation, and 2) practical issues relating to constraints of time and lack of suitable IT infrastructure. Most commonly described facilitators were capture of patient reported outcomes instead of clinician-reported indices, user-friendly data entry tools, administrative support, training and regulatory oversight. Many clinicians, particularly doctors, remained sceptical about the benefits of using standardised assessment tools over clinical judgment.ConclusionsThere are significant technical and human barriers to standardisation of clinical assessments for IBD in routine settings. These findings have several implications for efforts to implement clinical instruments in routine practice. Education and training, evidence-based guidance and better IT capabilities are needed in order to improve the capture of standardised information in busy clinical settings. Direct capture of patient reported outcomes is likely to provide a more feasible approach to capturing standardised outcomes as part of the care delivery process.ReferenceRoyal College of Physicians IBD Programme. National clinical audit of biological therapies. Annual report. 2016. https://www.rcplondon.ac.uk/projects/outputs/national-clinical-audit-biological-therapies-annual-report-2016 (accessed 10 January 2021).

• Publisher: BMJ Publishing Group Ltd and British Society of Gastroenterology,BMJ Publishing Group LTD
• Subject: Colitis / Decision making / Immunotherapy / Inflammatory bowel disease / Inflammatory bowel diseases / Patients / Qualitative research / Training