Electronic interviewing
From pelvic floor, pre op & beyond
24th June 2014
Stephen Radley MD FRCS FRCOG
Consultant Obstetri...
80.4
71.4
59.3 58.4
39.0
11.1
0%
20%
40%
60%
80%
100%
would
recommend
would
undergo
again
subjective
improvement
or cure
n...
Sacro-colpopexy
Sheffield Prolapse Questionnaire: Bradshaw et al, BJOG
The assessment of pelvic floor disorders
+ + +
+ +
Clinical
findings Investigation
s
Benefits of questionnaires
• Evaluate a patient’s well-being / outcome of
treatment in a systematic way
• Can provide reli...
Bristol female urinary
tract symptoms - Q
Birmingham
bowel & urinary
tract - Q
Sheffield prolapse
symptoms - Q
Female sexu...
Why an electronic
questionnaire ?
 Burden
 Utility (interactive, simple & easy, help pages)
Radley S et al. Development & validation of a questionnaire for the
assessment of bowel symptoms in women. BJOG 2002
Radle...
ePAQ – Pelvic Floor
Structure
• Introductory pages
• Questionnaire dimensions (up to 120 items)
Urinary
Bowel
Vaginal
Sexu...
Psychometric properties
Reliability / Validity / Responsiveness / Value / Burden
Computer interviewing in urogynaecology: ...
Value / Burden
Appropriate, accessible, practical & acceptable
Use in clinical practice?
Can patients & clinicians use it?...
ePAQ – Pelvic Floor
A questionnaire for clinical use
Screen shot: Standard ePAQ item structure
Symptoms
Impact
Quality of life
ePAQ summary report
ePAQ Detailed Report
(Example from part of Urinary Dimension)
Screening items
Responses
(0 = Never, 1 = Occasionally, 2 = ...
Symptoms
Impact
ePAQ Detailed report
(Lower Urinary Tract Symptoms)
QoL
Routine clinical care
0%
10%
20%
30%
40%
< 5 6 to 10 11 to 15 16 to 20 21 to 25 26 to 30 > 30
mins
Time to complete ePAQ
0%
10%
20%
30%
40%
50%
Strongly
agree
Mostly agree Neither
agree nor
disagree
Mostly
disagree
Strongly
disagree
'The quest...
Additional comments…
Helped express my problems enormously
Helped focus on urgent and relevant problem
Helped me express m...
Users
Manchester
Liverpool
Sheffield
Birmingham
Newcastle
Nottingham
Mansfield
Chesterfield
Kettering
South Tees
Scotland ...
‘Dual server technology’
N3
(NHS)
Personalised
Name, DoB, NHS
number, PAS-linked
WWW
(Internet)
Anonymous
Unique Voucher c...
The Virtual Clinic
79% Treatment planned or initiated
39% Referred to physiotherapy
44% Scheduled urodynamics
12% Clinic follow-up
8% Referre...
Positive aspects (0 = worst, 100 = best possible)
Communication (PEQ)
84 (SD = 16)
Value (QQ-10)
77 (SD 16)
Negative aspec...
0
20
40
60
80
100
Disagree
completely
Disagree So-so Agree Agree
completely
'I felt taken care of'%
Free text comments…
‘I preferred answering the more embarrassing questions via
the questionnaire than face to face’
‘Knowi...
Pre & post BOTOX (Virtual clinic)
Pre & post TVT (Virtual Clinic)
0
20
40
60
80
100
U P&S Voiding OAB SUI U QOL
Incontinence surgery: TVT pre and post op mean
ePAQ urinary domain scores (n...
Bowel symptoms following posterior repair
0
20
40
60
80
100
V P&S Capacity Prolapse V QOL
Prolapse pre and post op mean epaq vaginal scores
(n=46)
pre op mean
post ...
29 year old, Pakistani, Non-English speaking
Schizophrenia
Not examined
MSU -ve
Solifenacin 5mg
An integrated care pathway
N3 + www
1o care
2o care
3o care
ePAQ
Home
Internet
Standardisation
Clinical governance
Screening
& Triage
Secondary care
ePAQ: supporting patient centred & int...
ePAQ-MPH
ePAQ-Vulva
ePAQ-Knee
ePAQ-PO: Patient completed,
computerised pre-operative assessment.
ePAQ-PO
ePAQ-Vascular
(NIHR ScHARR)
Thank you
References
Computer interviewing in urogynaecology: concept, development and psychometric testing of an electronic
pelvic ...
Stephen radley - electronic interviewing
Stephen radley - electronic interviewing
Stephen radley - electronic interviewing
Stephen radley - electronic interviewing
Stephen radley - electronic interviewing
Stephen radley - electronic interviewing
Stephen radley - electronic interviewing
Stephen radley - electronic interviewing
Stephen radley - electronic interviewing
Stephen radley - electronic interviewing
Stephen radley - electronic interviewing
Stephen radley - electronic interviewing
Stephen radley - electronic interviewing
Stephen radley - electronic interviewing
Stephen radley - electronic interviewing
Stephen radley - electronic interviewing
Stephen radley - electronic interviewing
Stephen radley - electronic interviewing
Stephen radley - electronic interviewing
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Stephen radley - electronic interviewing

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Directors of communications from 15 Swedish county councils visited London to learn more about the health and care system in England.This presentation is from this visit.

NHS Improving Quality planned and hosted the study tour as a result of close links with Jönköping, one of the councils represented in the delegation. Our guests learned about the important role of communications specialists in transforming healthcare in England, and the leading role NHS Improving Quality has taken in engaging and mobilising staff at scale and pace.

During the study tour it became obvious that many of the challenges and opportunities we face in our health and care system mirror those in Sweden, in particular issues such as emergency care, obesity and smoking, patient safety and working with the media. This was a fantastic opportunity for NHS Improving Quality to strengthen alliances at an international level and share ideas and approaches, and we hope to build on this in the future

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Stephen radley - electronic interviewing

  1. 1. Electronic interviewing From pelvic floor, pre op & beyond 24th June 2014 Stephen Radley MD FRCS FRCOG Consultant Obstetrician & Gynaecologist Research lead Jessop Wing Sheffield Teaching Hospitals CEO, Director of R&D, EPAQ Systems Ltd
  2. 2. 80.4 71.4 59.3 58.4 39.0 11.1 0% 20% 40% 60% 80% 100% would recommend would undergo again subjective improvement or cure no GSI normal urodynamic study subjective cure Subjective & objective outcome following Macroplastique
  3. 3. Sacro-colpopexy Sheffield Prolapse Questionnaire: Bradshaw et al, BJOG
  4. 4. The assessment of pelvic floor disorders + + + + + Clinical findings Investigation s
  5. 5. Benefits of questionnaires • Evaluate a patient’s well-being / outcome of treatment in a systematic way • Can provide reliable information on physical, mental and social well-being • Can reduce embarrassment & from the clinical interview
  6. 6. Bristol female urinary tract symptoms - Q Birmingham bowel & urinary tract - Q Sheffield prolapse symptoms - Q Female sexual function index ICS Male Pelvic Floor Assessment (PAQ) Qs
  7. 7. Why an electronic questionnaire ?  Burden  Utility (interactive, simple & easy, help pages)
  8. 8. Radley S et al. Development & validation of a questionnaire for the assessment of bowel symptoms in women. BJOG 2002 Radley SC et al. Computer interviewing in urogynaecology. BJOG 2006
  9. 9. ePAQ – Pelvic Floor Structure • Introductory pages • Questionnaire dimensions (up to 120 items) Urinary Bowel Vaginal Sexual • Analysis, summary, printed report Interactive & optional dimensions
  10. 10. Psychometric properties Reliability / Validity / Responsiveness / Value / Burden Computer interviewing in urogynaecology: concept, development and psychometric testing of an electronic pelvic floor assessment questionnaire in primary and secondary care. Radley et al BJOG. 2006 Electronic pelvic floor symptoms assessment: Tests of data quality of ePAQ-PF. Jones et al. Int Urogynecol J Pelvic Floor Dysfunct. 2008 Responsiveness of ePAQ-PF. Jones et al Int Urogynecol J Pelvic Floor Dysfunct. 2009 Development of an instrument to measure face validity and feasibility of patient questionnaire use during healthcare: the QQ-10. Moores et al Int J Quality in Health Care (In press)
  11. 11. Value / Burden Appropriate, accessible, practical & acceptable Use in clinical practice? Can patients & clinicians use it? Cost: Patients, providers & society Use in different settings How does it impact on patient care?
  12. 12. ePAQ – Pelvic Floor A questionnaire for clinical use
  13. 13. Screen shot: Standard ePAQ item structure
  14. 14. Symptoms Impact Quality of life ePAQ summary report
  15. 15. ePAQ Detailed Report (Example from part of Urinary Dimension) Screening items Responses (0 = Never, 1 = Occasionally, 2 = Most of the time, 3 = all of the time)
  16. 16. Symptoms Impact ePAQ Detailed report (Lower Urinary Tract Symptoms) QoL
  17. 17. Routine clinical care
  18. 18. 0% 10% 20% 30% 40% < 5 6 to 10 11 to 15 16 to 20 21 to 25 26 to 30 > 30 mins Time to complete ePAQ
  19. 19. 0% 10% 20% 30% 40% 50% Strongly agree Mostly agree Neither agree nor disagree Mostly disagree Strongly disagree 'The questionnaire was helpful during my clinic visit'
  20. 20. Additional comments… Helped express my problems enormously Helped focus on urgent and relevant problem Helped me express my symptoms Made me realise the extent of my problem Helped talk at ease about my problems It was really easy to use Good, enjoyable, easy and quick! It was good fun Good idea, well done!
  21. 21. Users Manchester Liverpool Sheffield Birmingham Newcastle Nottingham Mansfield Chesterfield Kettering South Tees Scotland (Ayr) (Macclesfield) (Southport) (Stoke) (Bradford) (Leeds) 20,000+ Colorectal, Urology, Physiotherapy, Urogynaecology, Nurse Specialists
  22. 22. ‘Dual server technology’ N3 (NHS) Personalised Name, DoB, NHS number, PAS-linked WWW (Internet) Anonymous Unique Voucher code & DoB
  23. 23. The Virtual Clinic
  24. 24. 79% Treatment planned or initiated 39% Referred to physiotherapy 44% Scheduled urodynamics 12% Clinic follow-up 8% Referred to another clinic Virtual Clinic: First 50 patients
  25. 25. Positive aspects (0 = worst, 100 = best possible) Communication (PEQ) 84 (SD = 16) Value (QQ-10) 77 (SD 16) Negative aspects (0 = best, 100 = worst possible) Barriers (PEQ) 15 (SD = 15) Burden (QQ-10) 25 (SD = 16) Virtual Clinic: Satisfaction Data
  26. 26. 0 20 40 60 80 100 Disagree completely Disagree So-so Agree Agree completely 'I felt taken care of'%
  27. 27. Free text comments… ‘I preferred answering the more embarrassing questions via the questionnaire than face to face’ ‘Knowing that an examination was out of the question put me more at ease’ ‘Phone consultation excellent, relaxed & stress free’ ‘Thorough & informative way of doing things’ ‘I didn’t have to worry about childcare’
  28. 28. Pre & post BOTOX (Virtual clinic)
  29. 29. Pre & post TVT (Virtual Clinic)
  30. 30. 0 20 40 60 80 100 U P&S Voiding OAB SUI U QOL Incontinence surgery: TVT pre and post op mean ePAQ urinary domain scores (n=54) pre op mean post op mean Effect size: SUI = 2.4 U-QoL = 2.2
  31. 31. Bowel symptoms following posterior repair
  32. 32. 0 20 40 60 80 100 V P&S Capacity Prolapse V QOL Prolapse pre and post op mean epaq vaginal scores (n=46) pre op mean post op mean Effect size: Prolapse = 2.1 V-QoL = 1.0
  33. 33. 29 year old, Pakistani, Non-English speaking Schizophrenia Not examined MSU -ve Solifenacin 5mg
  34. 34. An integrated care pathway N3 + www 1o care 2o care 3o care ePAQ
  35. 35. Home Internet Standardisation Clinical governance Screening & Triage Secondary care ePAQ: supporting patient centred & integrated healthcare Clinical assessment Primary careResearch, Audit Service evaluation
  36. 36. ePAQ-MPH
  37. 37. ePAQ-Vulva
  38. 38. ePAQ-Knee
  39. 39. ePAQ-PO: Patient completed, computerised pre-operative assessment.
  40. 40. ePAQ-PO ePAQ-Vascular (NIHR ScHARR)
  41. 41. Thank you
  42. 42. References Computer interviewing in urogynaecology: concept, development and psychometric testing of an electronic pelvic floor assessment questionnaire (e-PAQ) in primary and secondary care. Radley et al. BJOG, 2006 QQ-10: An instrument to measure face validity and feasibility of questionnaire use in healthcare. Moores K, Jones G, Radley SC. Int J Quality in Health Care. 2012 Prolapse surgery and sexual function. Dua A, Jha S, Farkas A, Jones GL, Radley SC. International Urogynecology Journal. (Oct 2011) Effect of posterior colporrhaphy on anorectal function. Dua A, Jha S, Farkas A, Jones GL, Radley SC. International Urogynecology Journal. (2011) Quality of life measurement and electronic assessment in urogynaecology. Dua A, Radley SC. The Obstetrician & Gynaecologist (Sept 2011). Factors affecting the outcome of TVT. Jha S, Jones GL, Radley SC, Farkas AG. European Journal of Obs Gyn Repro Biol (Dec 2008) Responsiveness of ePAQ-PF. Jones GL, Lumb J, Radley SC, Farkas AG. Int Urogynecol J Pelvic Floor Dysfunct. (Dec 2008) Impact of TVT on Sexual function. Jha S, Radley SC, Farkas AG, Jones GL. Int Urogynecol J Pelvic Floor Dysfunct. (Nov 2008) Electronic pelvic floor symptoms assessment: tests of data quality of ePAQ-PF. Jones GL, Radley SC, Lumb J, Jha S. Int Urogynecol J Pelvic Floor Dysfunct. 2008 Jun
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