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

80.471.4

59.3 58.4

39.0

11.10%

20%

40%

60%

80%

100%

wouldrecommend

wouldundergo

again

subjectiveimprovement

or cure

no GSI normalurodynamic

study

subjectivecure

Subjective & objective outcome following

Macroplastique

Sacro-colpopexySheffield Prolapse Questionnaire: Bradshaw et

al, BJOG 2005

The assessment of pelvic floor disorders

+ + + + +

Clinical findings

Investigations

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

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

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 2002Radley SC et al. Computer interviewing in urogynaecology. BJOG 2006

ePAQ – Pelvic FloorStructure

• Introductory pages • Questionnaire dimensions (up to 120 items)

UrinaryBowelVaginalSexual

• Analysis, summary, printed report

Interactive & optional dimensions

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)

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?

ePAQ – Pelvic FloorA 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 itemsResponses

(0 = Never, 1 = Occasionally, 2 = Most of the time, 3 = all of the time)

Symptom

s

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%

Stronglyagree

Mostly agree Neitheragree nordisagree

Mostlydisagree

Stronglydisagree

'The questionnaire was helpful during my clinic visit'

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!

Users

ManchesterLiverpoolSheffieldBirminghamNewcastleNottinghamMansfieldChesterfieldKetteringSouth TeesScotland (Ayr)

(Macclesfield)(Southport)(Stoke)(Bradford)(Leeds)

20,000+ Colorectal, Urology,

Physiotherapy, Urogynaecology, Nurse Specialists

‘Dual server technology’

N3(NHS)

Personalised

Name, DoB, NHS number, PAS-linked

WWW(Internet)

AnonymousUnique Voucher code

& DoB

The Virtual Clinic

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

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

0

20

40

60

80

100

Disagreecompletely

Disagree So-so Agree Agreecompletely

'I felt taken care of'%

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’

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=54)

pre op mean

post op mean

Effect size: SUI = 2.4 U-QoL = 2.2

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 op mean

Effect size: Prolapse = 2.1 V-QoL = 1.0

29 year old, Pakistani, Non-English speaking

SchizophreniaNot examinedMSU -ve

Solifenacin 5mg

An integrated care pathway

N3 + www

1o care

2o care

3o care

ePA

Q

Home

Internet

Standardisation

Clinical governance

Screening

& Triage

Secondary care

ePAQ: supporting patient centred & integrated healthcare

Clinical assessment

Primary care

Research, AuditService evaluation

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 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