Directors of communications from 15 Swedish county councils visited London to learn more about the health and care system in England.This presentation is from this visit. NHS Improving Quality planned and hosted the study tour as a result of close links with Jönköping, one of the councils represented in the delegation. Our guests learned about the important role of communications specialists in transforming healthcare in England, and the leading role NHS Improving Quality has taken in engaging and mobilising staff at scale and pace. During the study tour it became obvious that many of the challenges and opportunities we face in our health and care system mirror those in Sweden, in particular issues such as emergency care, obesity and smoking, patient safety and working with the media. This was a fantastic opportunity for NHS Improving Quality to strengthen alliances at an international level and share ideas and approaches, and we hope to build on this in the future

1. Electronic interviewing
From pelvic floor, pre op & beyond
24th June 2014
Stephen Radley MD FRCS FRCOG
Consultant Obstetrician & Gynaecologist
Research lead
Jessop Wing
Sheffield Teaching Hospitals
CEO, Director of R&D, EPAQ Systems Ltd

2. 80.4
71.4
59.3 58.4
39.0
11.1
0%
20%
40%
60%
80%
100%
would
recommend
would
undergo
again
subjective
improvement
or cure
no GSI normal
urodynamic
study
subjective
cure
Subjective & objective
outcome following
Macroplastique

3. Sacro-colpopexy
Sheffield Prolapse Questionnaire: Bradshaw et al, BJOG

4. The assessment of pelvic floor disorders
+ + +
+ +
Clinical
findings Investigation
s

5. Benefits of questionnaires
• Evaluate a patient’s well-being / outcome of
treatment in a systematic way
• Can provide reliable information on physical,
mental and social well-being
• Can reduce embarrassment & from the
clinical interview

6. Bristol female urinary
tract symptoms - Q
Birmingham
bowel & urinary
tract - Q
Sheffield prolapse
symptoms - Q
Female sexual
function index
ICS
Male
Pelvic Floor
Assessment (PAQ)
Qs

7. Why an electronic
questionnaire ?
 Burden
 Utility (interactive, simple & easy, help pages)

8. Radley S et al. Development & validation of a questionnaire for the
assessment of bowel symptoms in women. BJOG 2002
Radley SC et al. Computer interviewing in urogynaecology. BJOG 2006

9. ePAQ – Pelvic Floor
Structure
• Introductory pages
• Questionnaire dimensions (up to 120 items)
Urinary
Bowel
Vaginal
Sexual
• Analysis, summary, printed report
Interactive &
optional
dimensions

10. Psychometric properties
Reliability / Validity / Responsiveness / Value / Burden
Computer interviewing in urogynaecology: concept, development and
psychometric testing of an electronic pelvic floor assessment
questionnaire in primary and secondary care. Radley et al BJOG. 2006
Electronic pelvic floor symptoms assessment: Tests of data quality of
ePAQ-PF. Jones et al. Int Urogynecol J Pelvic Floor Dysfunct. 2008
Responsiveness of ePAQ-PF. Jones et al
Int Urogynecol J Pelvic Floor Dysfunct. 2009
Development of an instrument to measure face validity and feasibility of
patient questionnaire use during healthcare: the QQ-10. Moores et al
Int J Quality in Health Care (In press)

11. Value / Burden
Appropriate, accessible, practical & acceptable
Use in clinical practice?
Can patients & clinicians use it?
Cost: Patients, providers & society
Use in different settings
How does it impact on patient care?

12. ePAQ – Pelvic Floor
A questionnaire for clinical use

14. Screen shot: Standard ePAQ item structure

32. Symptoms
Impact
Quality of life
ePAQ summary report

33. ePAQ Detailed Report
(Example from part of Urinary Dimension)
Screening items
Responses
(0 = Never, 1 = Occasionally, 2 = Most of the time, 3 = all of the
time)

34. Symptoms
Impact
ePAQ Detailed report
(Lower Urinary Tract Symptoms)
QoL

35. Routine clinical care

36. 0%
10%
20%
30%
40%
< 5 6 to 10 11 to 15 16 to 20 21 to 25 26 to 30 > 30
mins
Time to complete ePAQ

37. 0%
10%
20%
30%
40%
50%
Strongly
agree
Mostly agree Neither
agree nor
disagree
Mostly
disagree
Strongly
disagree
'The questionnaire was helpful during my clinic visit'

38. Additional comments…
Helped express my problems enormously
Helped focus on urgent and relevant problem
Helped me express my symptoms
Made me realise the extent of my problem
Helped talk at ease about my problems
It was really easy to use
Good, enjoyable, easy and quick!
It was good fun
Good idea, well done!

39. Users
Manchester
Liverpool
Sheffield
Birmingham
Newcastle
Nottingham
Mansfield
Chesterfield
Kettering
South Tees
Scotland (Ayr)
(Macclesfield)
(Southport)
(Stoke)
(Bradford)
(Leeds)
20,000+
Colorectal, Urology, Physiotherapy,
Urogynaecology, Nurse Specialists

40. ‘Dual server technology’
N3
(NHS)
Personalised
Name, DoB, NHS
number, PAS-linked
WWW
(Internet)
Anonymous
Unique Voucher code
& DoB

41. The Virtual Clinic

42. 79% Treatment planned or initiated
39% Referred to physiotherapy
44% Scheduled urodynamics
12% Clinic follow-up
8% Referred to another clinic
Virtual Clinic:
First 50 patients

43. Positive aspects (0 = worst, 100 = best possible)
Communication (PEQ)
84 (SD = 16)
Value (QQ-10)
77 (SD 16)
Negative aspects (0 = best, 100 = worst possible)
Barriers (PEQ)
15 (SD = 15)
Burden (QQ-10)
25 (SD = 16)
Virtual Clinic: Satisfaction Data

44. 0
20
40
60
80
100
Disagree
completely
Disagree So-so Agree Agree
completely
'I felt taken care of'%

45. Free text comments…
‘I preferred answering the more embarrassing questions via
the questionnaire than face to face’
‘Knowing that an examination was out of the question put me
more at ease’
‘Phone consultation excellent, relaxed & stress free’
‘Thorough & informative way of doing things’
‘I didn’t have to worry about childcare’

46. Pre & post BOTOX (Virtual clinic)

47. Pre & post TVT (Virtual Clinic)

48. 0
20
40
60
80
100
U P&S Voiding OAB SUI U QOL
Incontinence surgery: TVT pre and post op mean
ePAQ urinary domain scores (n=54)
pre op mean
post op mean
Effect size: SUI = 2.4 U-QoL = 2.2

50. Bowel symptoms following posterior repair

51. 0
20
40
60
80
100
V P&S Capacity Prolapse V QOL
Prolapse pre and post op mean epaq vaginal scores
(n=46)
pre op mean
post op mean
Effect size: Prolapse = 2.1 V-QoL = 1.0

52. 29 year old, Pakistani, Non-English speaking
Schizophrenia
Not examined
MSU -ve
Solifenacin 5mg

53. An integrated care pathway
N3 + www
1o care
2o care
3o care
ePAQ

54. Home
Internet
Standardisation
Clinical governance
Screening
& Triage
Secondary care
ePAQ: supporting patient centred & integrated healthcare
Clinical assessment
Primary careResearch, Audit
Service evaluation

55. ePAQ-MPH

56. ePAQ-Vulva

57. ePAQ-Knee

58. ePAQ-PO: Patient completed,
computerised pre-operative assessment.

59. ePAQ-PO
ePAQ-Vascular
(NIHR ScHARR)

60. Thank you

61. References
Computer interviewing in urogynaecology: concept, development and psychometric testing of an electronic
pelvic floor assessment questionnaire (e-PAQ) in primary and secondary care. Radley et al. BJOG, 2006
QQ-10: An instrument to measure face validity and feasibility of questionnaire use in healthcare.
Moores K, Jones G, Radley SC. Int J Quality in Health Care. 2012
Prolapse surgery and sexual function. Dua A, Jha S, Farkas A, Jones GL, Radley SC. International
Urogynecology Journal. (Oct 2011)
Effect of posterior colporrhaphy on anorectal function. Dua A, Jha S, Farkas A, Jones GL, Radley SC.
International Urogynecology Journal. (2011)
Quality of life measurement and electronic assessment in urogynaecology.
Dua A, Radley SC. The Obstetrician & Gynaecologist (Sept 2011).
Factors affecting the outcome of TVT. Jha S, Jones GL, Radley SC, Farkas AG.
European Journal of Obs Gyn Repro Biol (Dec 2008)
Responsiveness of ePAQ-PF. Jones GL, Lumb J, Radley SC, Farkas AG. Int Urogynecol J Pelvic Floor
Dysfunct. (Dec 2008)
Impact of TVT on Sexual function. Jha S, Radley SC, Farkas AG, Jones GL.
Int Urogynecol J Pelvic Floor Dysfunct. (Nov 2008)
Electronic pelvic floor symptoms assessment: tests of data quality of ePAQ-PF. Jones GL, Radley SC,
Lumb J, Jha S. Int Urogynecol J Pelvic Floor Dysfunct. 2008 Jun