IHE Report - Institute of Health Economics

et al 1996) were used in primary care practices as red flags in identifying bothemotional and physical problems. Wu (1996) also suggested that HRQLmeasures may have an important role in decision making and planningtreatment, helping to identify the most appropriate treatment for a particularpatient, for example when choosing between surgery or medical management.Recently several studies have presented evidence on the effects of using HRQLmeasures in routine clinical practice. In these studies patients completed theHRQL measures while waiting to be seen by their clinicians and the resultsfrom the questionnaires were feedback to the clinicians and available toclinicians for using during the patient visit. Further the HRQL results wereincluded in patient’s medical records. These studies [Taenzer et al (2000),Espallargues et al (2000) and Detmar et al. (2002)] provide evidence thatusing HRQL measures improves patient-clinician communication. Velikovaet al (2004) also detected impacts on the emotional well-being of patients.Furthermore, Haywood et al (2006) confirmed that the inclusion of HRQLin clinical care enhanced the patient participation in the consultationprocess through an improvement in patient-provider communication.Recently, a monograph produced by the U.S. National Cancer Instituteprovided important evidence on the effects of improved patient-cliniciancommunication on patient outcomes (Epstein and Street 2007).On the other hand, there are a number of studies for which with outcomeswere not positive. Finh et al (2004) found no improvement in patient outcomeand satisfaction. These results may be due to a number of barriers to usingHRQL measures in clinical care. The barriers may be broadly divided intothree categories: Clinicians-related issues, Patient-related issues, and propertiesof HRQL measures (Deyo R and Patrick DL 1989).Clinicians related issues: From the point of view of the healthcare providerthe main barriers are related to the effectiveness of the measure (what is theclinical relevance?), lack of familiarity with the results, and the difficulty offitting it into the office ecosystem (lack of time and resources). Morris et al(1998) studied the use of HRQL data in clinical practice. Clinicians fromthree different countries found it difficult to collect data in their clinics;time and resources were the main barriers. To overcome some of thesebarriers clinicians need to be trained in the use and interpretation of HRQLmeasures. Espallargues et al (2000) noted that clinicians modified patientcare as the result of receiving information on patient health status, concludingthat feedback on patient health status should be provided to clinicians onregular basis.Patient related issues: The main concerns of patients are related to thedisclosure of information (insurance status) and burdens associated withcompleting the questionnaires. For instance, anxiety and depression questionscan be intrusive.The Importance of Measuring Health-related Quality of Life 10