Reference
Monahan, P. O., Kroenke, K., Callahan, C. M., Bakas, T., Harrawood, A., Lofton, P., Frye, D., Draucker, C., Stump, T., Saliba, D., Galvin, J. E., Keegan, A., Austrom, M. G., & Boustani, M. (2019). Development and Feasibility of SymTrak, aMulti-domain Tool for Monitoring Symptoms of Older Adults in Primary Care. Journal of general internal medicine, 34(6), 915–922. https://doi.org/10.1007/s11606-018-4772-4
At a glance
A recent article assessed the state of health of a population of elderly persons with chronic diseases, through a tool for monitoring self-reported or caregiver-reported symptoms, in primary care settings.
The context
Most of the patients who come to primary care settings are elderly and suffer from multiple chronic conditions (CCM), such as diabetes, heart failure, dementia, musculoskeletal disorders and depression. These types of patients sometimes require complex healthcare and treatment, with significant healthcare costs. In fact, these expenditures account for two-thirds of the total health care costs in the United States.
Chronic conditions are associated with a variety of physical complaints, functional symptoms, and cognitive, behavioral, and psychological disorders. The SPADE symptoms – sleep disturbance, pain, anxiety, depression, and fatigue – comprise five of the most common under-treated symptoms in people with chronic conditions.
These symptoms tend to occur simultaneously (e.g., pain and depression have a co-presence of 30-50% in chronic diseases) and often interact synergistically, negatively affecting both physical and social well-being.
In this study, the SymTrak was found to be a valid tool for at-home disease monitoring and was useful in predicting possible relapses in patients with chronic disease. This device tracks symptoms over time, improves diagnoses, guides treatment, assesses disease severity, and monitors response to treatment over time.
Study characteristics
This study consists of two phases. The first phase involved content validity and analysis of the dataset, which was derived from symptom measurement scales such as the Somatic Symptom Scale-8 (SSS-8), Patient Health Questionnaire somatic symptom module (PHQ-15), Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7), PEG pain scale, and Health Aging Brain (HABC). PRO (Patient Reported Outcome) questionnaires were also analyzed in order to assess health status and monitor the outcome results reported by both patients and caregivers. Focus groups and interviews were conducted with healthcare professionals (physicians, nurses) and with patients and informal caregivers belonging to a network of primary care clinics affiliated with the University of Indianapolis (USA). The aim of the focus groups and interviews was to assess the response options of the tool (4 possible answers) and administration time (2 weeks). The second phase involved a pilot feasibility study, where the SymTrak monitoring system was administered. For this phase, there were 81 participants, including: 27 patient-caregiver pairs and 27 patients without an identified caregiver.
Results
In phase 1, sleep disturbance, pain, anxiety state, depression, and fatigue were examined as possible domains to investigate. These were all confirmed by clinicians as disabling factors of chronic illness. The significance of the tool for monitoring symptoms over time emerged from the focus groups. Monitoring nutritional status was evaluated as relevant, making it appropriate to include with the aforementioned domains. An established frequency of two weeks was considered valid and sufficient to monitor the course of the disease and any changes in the perceived state of health. The tool can be administered either by health personnel at follow-up visits, or by the patient or caregiver. The completion time is quite short, about 5 minutes. Phase 2, the pilot study of internal reliability and tool usability, investigated some aspects of item comprehension and health literacy. In this phase, the enlisted elderly patients differed in age, education level, ethnicity, income, and marital status.
The tool showed good internal reliability (Cronbach’s Alpha coefficient of 0.79 to 0.86). Regarding usability, a whole series of questions was submitted to the participants (clinicians, patients, and caregivers) that focused on the importance of the items and comprehension of the terms used.
Study limitations
The main limitation of this study lies in the sample size; in fact, the authors state that it was not possible to perform factor analysis. This study can only be generalized to adults 65 years and older, and so further investigation is needed for adults 18 years and older. Therefore, a larger sample psychometric study is needed to confirm the results.
What’s new
The use of a monitoring tool to detect symptoms in patients with chronic diseases has multiple prognostic and treatment benefits. Incorporating PRO (Patient Reported Outcome) tools into clinical settings through technological aids (e.g., tablets, secure websites) represents an effective strategy for monitoring patients with chronic diseases in primary care settings as well as at home. The data provided by the measurements, and represented graphically, would illustrate temporal trends that could be useful to clinicians in making future decisions regarding disease treatment and symptom stabilization.
The prospects
The SymTrak has a strong content validity and internal reliability; it has further been shown to be easy to use, efficient, and fast for clinicians to manage.
Edited by Michela Barisone
