140 Chapter 5 PROM portal adaptable for mobile phone use, and realized a front-end (hybrid) integration with the EHR in 2019. With this integration, clinicians can now view the KLIK ePROfile in the EHR and discuss the PROMs more easily. However, to be able to automatically link the appointments to KLIK, a full integration is necessary, which can hopefully be realized in the future. A final difference between the focus group and questionnaire outcomes was the satisfaction with the layout of the KLIK PROM portal, which was mainly mentioned as a point of improvement in the questionnaire. Patients and parents indicated that the website looks a bit old-fashioned and could be made more attractive by using visuals. For this reason, the homepage of the KLIK website was upgraded recently. The design of the website was changed (e.g., by using visuals and creating a more professional look). In addition, specific information pages are now available for all KLIK users (pediatric patients, parents, adult patients, and clinicians). Patients and parents mentioned in both the focus groups as the questionnaires that clinicians often do not discuss PROMs during the consultation. This is worrisome, as patients and parents indicated that this is an important reason why KLIK sometimes has no added value for the consultation which consequently may lead to loss of motivation to complete KLIK PROMs. To improve this discussion rate, several implementation strategies were used. For example, the KLIK expert team revised the KLIK training in which more attention is now paid to the importance of discussing PROMs [43] and this topic is discussed more thoroughly during annual evaluation meetings with clinicians [16], with the goal to increase their knowledge, awareness and confidence in discussing PROMs. Additionally, finding champions for each multidisciplinary team to motivate clinicians to use and discuss KLIK PROMs would be beneficial as this was identified as the most important implementation strategy in two KLIK studies [15, 17]. When clinicians do not discuss the completed PROMs, patients and some parents indicated that they do not dare to bring up for them important themes themselves. To empower patients/parents and increase their self-efficacy, educational videos were developed and made available on the KLIK homepage (article in preparation). In these videos tips and tricks are provided how patients and parents can prepare themselves for the consultation and bring up topics they want to discuss with the clinician. When comparing this study with the KLIK evaluation study with clinicians [16], similar experiences regarding the KLIK PROM portal were mentioned. For example, insight into patients’ functioning, improved communication, and better preparation
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