Patient capacity for self-care in the medical record of patients with chronic conditions: a mixed-methods retrospective study
| Autor: | Maria Kyriacou, Kasey R. Boehmer, Victor M. Montori, Megan E. Branda, Emma Behnken |
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| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Male
Treatment burden Chronic conditions Electronic medical record Minimally disruptive medicine Chronic illness Health Services Accessibility Medical Records Social Networking 0302 clinical medicine Documentation Health care Economic Status Multiple Chronic Conditions 030212 general & internal medicine Radiation treatment planning Qualitative Research lcsh:R5-920 030503 health policy & services Medical record Middle Aged Patient capacity Female Medical emergency 0305 other medical science Family Practice lcsh:Medicine (General) Treatment planning Research Article Adult Electronic health record Environment 03 medical and health sciences medicine Humans Aged Retrospective Studies Social network business.industry Self-Management Multimorbidity Repeated measures design Retrospective cohort study medicine.disease Self Care Content analysis Chronic Disease Linear Models business |
| Zdroj: | BMC Family Practice, Vol 19, Iss 1, Pp 1-7 (2018) BMC Family Practice |
| ISSN: | 1471-2296 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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