Updated: January 2016
ePAQ (electronic Personal Assessment Questionnaire) is a validated, web-based clinical assessment system, specifically designed to provide detailed, reliable and meaningful self-reported symptoms & quality of life data from women with pelvic floor disorders.1,2,3,4 Although primarily designed as a clinical assessment tool to support patient assessment, ePAQ is also recognised by NICE and the British Society of Urogynaecology (BSUG) as a responsive & meaningful patient reported outcome measure (PROM).11,12,13 ePAQ enables the delivery of virtual clinics and provides valuable outcomes data for activities including audit, service evaluation, revalidation, appraisal and research.14-22 ePAQ has a number of potential applications and benefits to clinicians, providers and patients, which are summarised below.
Units & individual clinicians are increasingly required to provide outcomes data in order to evaluate the quality and efficiency of services provided. This is now a key element in the accreditation of specialist units in urogynaecology.33 Experience in the UK has demonstrated the benefit of using ePAQ in this context; Providing embedded meaningful outcomes measurement in routine clinical practice.
The final item in all ePAQ questionnaires asks patients whether they are willing to allow their data to be used confidentially in appropriately registered research, audit and service evaluation projects: 95% of women who use ePAQ-PF agree to this, thereby enabling in-depth quality assessments of services, based on accurate & meaningful patient reported outcomes data. A growing number of peer reviewed publications have utilised these data effectively (see below).
Clinicians require outcomes data relating to their own practice for the purposes of appraisal and revalidation. Routine measurement of outcome using ePAQ, readily lends itself to this process. In addition, the inclusion of ‘Friends and Family’ and ‘Global rating of outcome’ scales within ePAQ, also supports such activity. Free text items relating to patients’ goals, concerns, questions and comments, further enrich the dataset with qualitative data, enabling & encouraging patient self-expression & engagement.
ePAQ serves as an adjunct to traditional clinical consultation, presenting a patient’s symptom profile & associated quality of life impact graphically. The instrument is reliable & responsive to change; its use has been validated in a number of studies since its inception in 2003. ePAQ has been shown to have high patient acceptability & value, with low burden. It improves discussion rates of intimate issues and the evaluation of sensitive conditions & problems. ePAQ is completed by patients prior to appointments; patient care may thus be more efficient, informed, focussed & effective.9,10
ePAQ-PF can improve efficiency: Saving clinic time, both in virtual (telephone) and outpatient clinics. New outpatient appointments may be up to ten minutes shorter, thereby allowing more new appointments to be provided. Virtual clinic consultations are approximately 50% shorter than face to face attendances.30
The use of paper-based questionnaires in order to monitor outcomes, is not itself without significant cost implications, previously estimated at £7 per patient episode. In a unit seeing 500 new patients / year, this would carry an implementation cost of 500 x £7 = £3,500 per annum. Paper questionnaires are less useful & more costly to deploy in clinical practice; lacking the instantaneous data analysis and storage afforded by ePAQ.11, 16, 17, 18, 19, 31
NICE Guidelines state that urodynamic investigation may not be required prior to surgery in a significant number of women with stress urinary incontinence. ePAQ provides an objective, patient-based assessment of stress incontinence and overactive bladder, which enables informed clinical decision making, including the use or non-use of urodynamics in this context. University of York (YHEC) metrics suggest that reduced requirement for urodynamic investigation due to improved diagnostics provided by ePAQ: Assuming trusts undertake 400 Urodynamic tests per year (2007‐'08 national tariff cost = £176) and use of ePAQ removes this requirement in 20% of cases (i.e. 80 patients per year) this would provide a potential saving of £176 x 80 = £14,080 per Trust, per annum.32
ePAQ-PF provides a central element and basis for case discussions held in regular MDT meetings. The documented objective views of the patient themselves provided by ePAQ summary & detailed reports are routinely presented, particularly when discussing patients with complex, chronic or recurrent conditions. In the Sheffield Urogynaecology MDT, up to 10 cases are presented and discussed weekly; Management decisions for all patients can be based on objective & detailed assessments, including the free text items such as BMI data and ‘Personal Goals’, which are of value when discussing patients with colleagues in an MDT or similar setting.5
ePAQ-PF has been used extensively in perineal trauma & OASI clinics, where it is particularly valuable in monitoring outcomes and identifying issues such as faecal incontinence, vaginal capacity and sexual function, as well as using free text items relating to patients’ personal concerns and questions.
Devolving patient care to specialist nurse-led clinics, either in primary or secondary care, provides the opportunity for efficiency and effective use of resources, whilst maintaining high standards and continuity of care. Selected patients, such as those undergoing routine surgery for prolapse or incontinence may be followed up in these clinics, supported by ePAQ, to enable quality control and monitoring of outcomes. Women undergoing Botox injection for OAB may be similarly managed in this way, with access to consultant led care for repeat Botox injection, supported by evidence-based, protocol driven pathways of care.
Joint clinics involving colorectal and urology are supported by ePAQ, which is routinely used for women attending these clinics with functional pelvic floor disorders. The use of a standardised assessment tool and outcome measure in this context enables collaborative working and helps to identify key areas for focus and prioritisation. The system also provides the opportunity for evaluating new services and practices, such as Sacral Nerve Stimulation, Botox and pharmacotherapy.16, 20, 21
In the context of the Virtual Clinic, ePAQ-PF supports telephone consultation for selected new & follow-up patients resulting in triage to the most appropriate service, investigation, treatment or discharge to primary care, thereby reducing the number of hospital appointments, associated travel & time for patients and reducing clinic costs and consultation times for providers. This service has been found to be highly acceptable to patients, particularly following surgical intervention such as incontinence or prolapse surgery, or Botox treatment for overactive bladder. In Sheffield, where virtual clinic follow up is routinely offered to women undergoing routine prolapse surgery, 75% choose virtual clinic follow-up (ePAQ + telephone consultation) in preference to outpatient department attendance. The cost savings of Virtual Clinics is £28 per patient. Based on 300 such prolapse procedures being carried out per year & 75% of patients being suitable for virtual follow-up (i.e. 225) this equates to a maximum of £6,300 per annum.28, 29, 30