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• Patient questionnaires in routine clinical care
  Yusuf Yazici
  Published on: 14 November 2005

• Published on: 14 November 2005

  Patient questionnaires in routine clinical care

  • Yusuf Yazici, Rheumatologist

  Dear Editor

  I have read the article by Kvien et al. with great interest (1). I agree with their conclusion that PDA and other electronic media have a future in data collection not only in clinical trials but also possibly in routine clinical care, even in patients’ homes. However, I disagree with some of the points they raise.

  First, they state that patients were more satisfied with PDA than paper. I...

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  Dear Editor

  I have read the article by Kvien et al. with great interest (1). I agree with their conclusion that PDA and other electronic media have a future in data collection not only in clinical trials but also possibly in routine clinical care, even in patients’ homes. However, I disagree with some of the points they raise.

  First, they state that patients were more satisfied with PDA than paper. I would think this would be expected since the recruitment involved explaining what would be done and patients with interest and/or favorable opinion about electronics in general would have been recruited. It is also not surprising that they managed to use a PDA, it is more likely that if they had heard of or used a PDA before that they would respond favorably to participate. One way to see if this holds true would be to give the PDA or paper version to the next 100 patients in a routine care setting and see how they do.

  Second, the distinction between patient questionnaires for clinical research and routine care has to be made. An 8 page paper questionnaire rarely succeeds in everyday rheumatology care (2). This is one of the reasons very few clinicians utilize patient questionnaires in their routine care, associating them with the lengthy research questionnaires (3). Third, even though PDAs might be cheaper than before, they are still not as cheap as pen and paper, even when you include time for a research assistant and/or secretary to enter the data, which can easily be maintained in a flow sheet, and does not necessarily require a computer (personal experience).

  I have implemented a system of giving patient questionnaires (MDHAQ) to each and every patient every time they are seen in the office since 2001 (4). One of the main reasons for its success has been the ease of giving everyone a 2 page questionnaire which includes 80% of the outcomes measures utilized by most clinical trials.

  One of our initial efforts should be to increase the use of these very simple to administer and score questionnaires. An MDHAQ, by the virtue of ease of use, applicability to not only RA but other diagnoses seems like a very good candidate (5). Having a front desk in real life patient care decide which patient can handle a PDA, which one needs a paper version, let alone which disease specific questionnaire to give to which patient, is only going to make the real life application of this technology more difficult in routine care at this time. It could become yet another impediment to the use of patient questionnaires in routine care. I believe the effort and time that may be devoted to establishing wireless, fire walled, PDA environments can be better utilized using and spreading the word on benefits of a simple pen and paper patient questionnaire in routine clinical care.

  References

  1- Kvien TH, Mowinckel P, Heiberg T, Dammann KL, Dale O, Aanerud GJ, Alme TN. Performance of helath status measures with a pen based personal digital assisstan. Ann Rheum Dis 2005; 64: 1480-4.

  2- Pincus T, Wolfe F. Patient questionnaires for clinical research and improved standard patient care: is it better to have 80% of the information in 100% of patients or 100% of the information in 5% of patients? J Rheumatol. 2005; 32: 575-7.

  3- Pincus T, Sokka T. Should contemporary rheumatoid arthritis clinical trials be more like standard patient care and vice versa? Ann Rheum Dis. 2004; 63 Suppl 2:ii32-ii39.

  4- Yazici Y. A database in private practice: the Brooklyn Outcomes of Arthritis Rheumatology Database (BOARD). Clin Exp Rheumatol 2005; 23 (Suppl. 39): S182-S187.

  5- Pincus T, Yazici Y, Bergman M. Development of a multi-dimensional health assessment questionnaire (MDHAQ) for the infrastructure of standard clinical care. Clin Exp Rheumatol 2005; 23 (Suppl. 39): S19-S28.

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  Conflict of Interest:
  None declared.

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