Patient-centred outcomes on the rise

FOCUSING on cardiovascular health outcomes that matter most to patients will lead to improved and more cost-effective care, says an Australian expert after a call for patient-reported health status to be more widely considered in clinical practice and research.

Professor John Beltrame, professor of medicine at the University of Adelaide and consultant cardiologist at the Queen Elizabeth Hospital, said that in recent years doctors had become too focused on the disease rather than on the more holisitic approach of how the disease impacted on the patient.

In a scientific statement published in Circulation, the American Heart Association (AHA) said patient-reported health status should be included “as a key measure of cardiovascular health in clinical research, clinical practice and disease surveillance”. (1)

The AHA said patient-reported health status included symptom burden (the frequency and types of symptoms), functional status (how the symptoms impact on the patient’s physical, mental/emotional and social functioning) and health-related quality of life (the discrepancy between actual and desired functional status for a patient and the overall impact on health). It was an important but underused measure of cardiovascular health, the AHA said.

Professor Beltrame, who is also the international representative of the leadership committee for the AHA Council on Quality Care and Outcomes Research and a fellow of the AHA, said the US was leading the way in patient-centred outcomes research.

He said his research group at the Queen Elizabeth Hospital had undertaken research in this area, but much still needed to be done for the approach to become “mainstream” in Australia. (2)

Symptoms such as angina could affect the lives of some patients more than others and this needed to be taken into account when deciding upon treatment options, Professor Beltrame said.

“Medicine is [both] a science and an art. The science is knowing and understanding the evidence relating to our therapies, but the art is applying this for each individual patient. The problem is we really have limited insight into how many therapies impact on our patient’s health status”, he said.

In its statement, the AHA said patient-reported health status was a strong, independent predictor of other health outcomes, including mortality, cardiovascular events and hospitalisation.

“Although there are performance tests that can help quantify physical functional status (eg, exercise treadmill testing), most aspects of patient health status are best captured by patient self-report. HRQL reflects how an individual views and adapts to his symptom burden, functional limitations and prognosis, as well as how patients perceive their overall health”, it stated.

Professor Beltrame said a patient-centred approach would help to determine the appropriateness of investigations and have an impact on health expenditure.

“Considering the rising cost of health care, we have to do things smarter — that’s clearly the way of the future. Talking to patients and understanding the impact of the disease on their health is not only inexpensive but may also reduce the costs of utilising diagnostic investigations and therapies that the individual patient may not desire.”

Consumers Health Forum of Australia CEO Carol Bennett welcomed a greater focus on individual patient engagement in their health.

“[The statement] does certainly show that patient-reported health status is a really important thing to be doing when you want to measure health outcomes”, Ms Bennett told MJA InSight.

“In Australia, we probably don’t tend to do this anywhere near the degree to which we should, there isn’t a culture of measuring consumer experience at all, which I think is disappointing”, she said.

“There are real benefits in engaging patients in their care and encouraging them to take responsibility for their health.”

More broadly, Ms Bennett said Australia was becoming more alert to the needs of measuring patient care experiences. She said the National Health Performance Authority, the Australian Institute of Health and Welfare and the Australian Bureau of Statistics (through the Council of Australian Governments’ health reform process) were now starting to measure patient experience.

“It is starting to become part of the culture and I think increasingly that will happen because it has happened everywhere else around the world”, she said.

Lead author of the AHA’s scientific statement, Professor John Rumsfeld, will chair a live video link between the AHA’s Quality Care Outcomes Research Council and the Australian National Heart Foundation at the foundation’s conference in Adelaide this week (16–18 May).

1. Circulation 2013; Online 6 May
2. Angiology 2012; 63: 223-228