Improving Measurement of Patient Responsiveness Using a Mixed Methods Approach

NICOLE WAGNER
PhD, Kaiser Permanente Colorado Institute for Health Research

Uptake of a new health intervention is dependent on patient acceptance and responsiveness. 1) Patient report is frequently used to assess patient responsiveness due to the low cost and limited labor requirements. 2) However, patient report is prone to errors, such as over-reporting and missing data. 2), 3) Incorporating measures of patient responsiveness from multiple sources presents an opportunity to sustain the low cost and labor requirements while increasing data accuracy and comprehensiveness. Measures from multiple sources may also provide an opportunity to identify strategies for adaptation. 4) To assess the value of a mixed methods approach, this study describes the use of electronic health record (EHR) data, patient report, and implementor logs for measuring patient responsiveness in a pragmatic intervention trial.

Just in Case (JIC) was a cluster randomized intervention trial, designed to increase the uptake of naloxone, an overdose antagonist medication, in patients on chronic opioid therapy. JIC was conducted between 2017 and 2019 at Denver Health Medical Center, a safety net health system serving the Denver metro area. Patients 18 years and older filling chronic opioid medications were eligible to receive naloxone co-dispensing. Eligible patients were recruited to complete surveys at baseline, 4 months, and 8 months (patient report). Pharmacy staff in the intervention arm recorded naloxone co-dispensing events and reasons for nonacceptance in a pharmacy fidelity log (implementor log).

Patient responsiveness measures included naloxone uptake and barriers to naloxone uptake. Naloxone uptake was captured in the EHR using naloxone dispensing data. Reasons for not accepting naloxone were coded for common themes in patient report surveys and implementor log.

Using EHR pharmacy records, 527 eligible patients were identified with 204 naloxone fills. Barriers to naloxone uptake from patient report included lack of knowledge on naloxone (40%), not thinking they needed it (88%), and fear of repercussions from pharmacists or doctors (20%). Barriers to naloxone uptake from implementors included patients already had naloxone (36%) and weren’t willing to pay for naloxone (28%).

A mixed methods approach using measures from the EHR, patients, and implementors provides a comprehensive assessment of patient responsiveness with increased accuracy. Each measure contributed unique data to inform potential opportunities for improvement and adaptation. EHR data contributed accurate counts of acceptance. Patient report identified a knowledge gap indicating a more robust education program may be needed. Implementors reported cost issues indicating a potential protocol modification could improve uptake.