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Patient capacity for self-care in the medical record of patients with chronic conditions: a mixed-methods retrospective study

BACKGROUND: Patients with chronic conditions must mobilize capacity to access and use healthcare and enact self-care. In order for clinicians to create feasible treatment plans with patients, they must appreciate the limits and possibilities of patient capacity. This study seeks to characterize the...

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Autores principales: Boehmer, Kasey R, Kyriacou, Maria, Behnken, Emma, Branda, Megan, Montori, Victor M
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6169082/
https://www.ncbi.nlm.nih.gov/pubmed/30285746
http://dx.doi.org/10.1186/s12875-018-0852-0
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author Boehmer, Kasey R
Kyriacou, Maria
Behnken, Emma
Branda, Megan
Montori, Victor M
author_facet Boehmer, Kasey R
Kyriacou, Maria
Behnken, Emma
Branda, Megan
Montori, Victor M
author_sort Boehmer, Kasey R
collection PubMed
description BACKGROUND: Patients with chronic conditions must mobilize capacity to access and use healthcare and enact self-care. In order for clinicians to create feasible treatment plans with patients, they must appreciate the limits and possibilities of patient capacity. This study seeks to characterize the amount, nature, and comprehensiveness of the information about patient capacity documented in the medical record. METHODS: In this mixed-methods study, we extracted notes about 6 capacity domains from the medical records of 100 patients receiving care from 15 primary care clinicians at a single practice. Using a generalized linear model to account for repeated measures across multiple encounters, we calculated the rate of documented domains per encounter per patient adjusted for appointment type and number. Following quantitative analyses, we purposefully selected records to conduct inductive content analysis. RESULTS: After adjusting for number of appointments and appointment type, primary care notes contained the most mentions of capacity. Physical capacity was most noted, followed by personal, emotional, social, financial, and environmental. Qualitatively, we found three documentation patterns: patients with broad capacity notes, patients with predominantly physical domain capacity notes, and patients with capacity notes mostly in domains other than physical. Records contained almost no mention of patients’ environmental or financial capacity, or of how they coped with capacity limitations. Rarely, did notes ever mention how well patients interacted with their social network or what support they provided to the patient in managing their health. CONCLUSION: Medical records scarcely document patient capacity. This may impair the ability of clinicians to determine how patients can handle patient work, at what point patient capacity might become overwhelmed leading to poor adherence and health outcomes, and how best to craft feasible treatment programs that patients can implement with high fidelity.
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spelling pubmed-61690822018-10-10 Patient capacity for self-care in the medical record of patients with chronic conditions: a mixed-methods retrospective study Boehmer, Kasey R Kyriacou, Maria Behnken, Emma Branda, Megan Montori, Victor M BMC Fam Pract Research Article BACKGROUND: Patients with chronic conditions must mobilize capacity to access and use healthcare and enact self-care. In order for clinicians to create feasible treatment plans with patients, they must appreciate the limits and possibilities of patient capacity. This study seeks to characterize the amount, nature, and comprehensiveness of the information about patient capacity documented in the medical record. METHODS: In this mixed-methods study, we extracted notes about 6 capacity domains from the medical records of 100 patients receiving care from 15 primary care clinicians at a single practice. Using a generalized linear model to account for repeated measures across multiple encounters, we calculated the rate of documented domains per encounter per patient adjusted for appointment type and number. Following quantitative analyses, we purposefully selected records to conduct inductive content analysis. RESULTS: After adjusting for number of appointments and appointment type, primary care notes contained the most mentions of capacity. Physical capacity was most noted, followed by personal, emotional, social, financial, and environmental. Qualitatively, we found three documentation patterns: patients with broad capacity notes, patients with predominantly physical domain capacity notes, and patients with capacity notes mostly in domains other than physical. Records contained almost no mention of patients’ environmental or financial capacity, or of how they coped with capacity limitations. Rarely, did notes ever mention how well patients interacted with their social network or what support they provided to the patient in managing their health. CONCLUSION: Medical records scarcely document patient capacity. This may impair the ability of clinicians to determine how patients can handle patient work, at what point patient capacity might become overwhelmed leading to poor adherence and health outcomes, and how best to craft feasible treatment programs that patients can implement with high fidelity. BioMed Central 2018-10-02 /pmc/articles/PMC6169082/ /pubmed/30285746 http://dx.doi.org/10.1186/s12875-018-0852-0 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Boehmer, Kasey R
Kyriacou, Maria
Behnken, Emma
Branda, Megan
Montori, Victor M
Patient capacity for self-care in the medical record of patients with chronic conditions: a mixed-methods retrospective study
title Patient capacity for self-care in the medical record of patients with chronic conditions: a mixed-methods retrospective study
title_full Patient capacity for self-care in the medical record of patients with chronic conditions: a mixed-methods retrospective study
title_fullStr Patient capacity for self-care in the medical record of patients with chronic conditions: a mixed-methods retrospective study
title_full_unstemmed Patient capacity for self-care in the medical record of patients with chronic conditions: a mixed-methods retrospective study
title_short Patient capacity for self-care in the medical record of patients with chronic conditions: a mixed-methods retrospective study
title_sort patient capacity for self-care in the medical record of patients with chronic conditions: a mixed-methods retrospective study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6169082/
https://www.ncbi.nlm.nih.gov/pubmed/30285746
http://dx.doi.org/10.1186/s12875-018-0852-0
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