(PS10-B37) A Qualitative Examination of Possible Factors for Noncompliance of Patient Reported Outcome Measures in a Telehealth Setting

Measurement Based Care (MBC) is considered to be an evidence-based practice. Despite its well-documented efficacy, it is underutilized in the clinical community for various reasons, including clinician and patient buy-in. A key component to the successful implementation of MBC is the routine administration of Patient Reported Outcome Measures (PROMs). It follows that one of the major barriers to the widespread success of MBC is noncompliance of PROMs. There is a distinct lack of research describing the utilization of MBC in a telehealth setting. As technological innovations continue, a greater number of clinics are offering telemental health services. The present study sought to elucidate possible factors associated with noncompliance of PROMs by patients experiencing telehealth services. A qualitative analysis was conducted in order to examine possible qualitative relationships between patients experiencing telehealth and failing to fill out PROMs by examining trends in progress notes of each patient. Participants (n = 22) were collected from a clinical population experiencing telehealth services at a community based psychological training clinic. Qualitative data, specifically the text within each “Assessment/Evaluation Data” section of each session note, was manually obtained for each telehealth modality patient and coded into recording units “Technical Difficulties,” “Life Event/Stressors,” “Forgot,” and “No Explanation.” Of the 119 session notes, taken from 22 patients (9 child, 13 adult), 1 (1%) was categorized as “Forgot,” 4 (3%) were categorized as “Life Events/Stressors,” 25 (21%) were categorized as “Technical Difficulties,” and 89 (75%) were categorized as “No Explanation.” Three-quarters of progress notes failed to specify any reason for patients failing to fill out PROMs for any given session. It is possible that literature detailing potential difficulties in achieving high patient compliance of PROMs could be related to complications with recordkeeping. Nearly a quarter of all progress notes described technical difficulties as a reason for failing to fill out PROMs. It is possible that the advanced technology associated with delivering telehealth services to patients presents a significant barrier to the completion of PROMs to certain patients (e.g., elderly, computer illiterate, low-income). Given the importance of PROM completion to successful utilization of MBC, it may be prudent for clinics relying heavily on MBC interventions to keep careful track of why patients may fail to fill out measures. Additionally, more or less technical support may need to be offered in order to ameliorate issues related to technical difficulties and failure to fill out PROMs. A crucial step in offering widespread care to as many people as possible through telehealth is to better understand potential barriers to the implementation of efficacious therapeutic techniques and develop strategies to overcome these barriers. Future studies may determine factors associated with difficulties with comprehensive recordkeeping of PROM noncompliance in the form of session notes as well as reliably using computer and/or advanced software and examine the potential relationship between those factors and PROM compliance.