Patient capacity for self-care in the medical record of patients with chronic conditions: a mixed-methods retrospective study
Abstract 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 character...
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Format: | Article |
Language: | English |
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BMC
2018-10-01
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Series: | BMC Family Practice |
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Online Access: | http://link.springer.com/article/10.1186/s12875-018-0852-0 |
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author | Kasey R Boehmer Maria Kyriacou Emma Behnken Megan Branda Victor M Montori |
author_facet | Kasey R Boehmer Maria Kyriacou Emma Behnken Megan Branda Victor M Montori |
author_sort | Kasey R Boehmer |
collection | DOAJ |
description | Abstract 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. |
first_indexed | 2024-04-13T12:27:59Z |
format | Article |
id | doaj.art-618c021e2b254b368fa0bd1a831208db |
institution | Directory Open Access Journal |
issn | 1471-2296 |
language | English |
last_indexed | 2024-04-13T12:27:59Z |
publishDate | 2018-10-01 |
publisher | BMC |
record_format | Article |
series | BMC Family Practice |
spelling | doaj.art-618c021e2b254b368fa0bd1a831208db2022-12-22T02:46:57ZengBMCBMC Family Practice1471-22962018-10-011911710.1186/s12875-018-0852-0Patient capacity for self-care in the medical record of patients with chronic conditions: a mixed-methods retrospective studyKasey R Boehmer0Maria Kyriacou1Emma Behnken2Megan Branda3Victor M Montori4Knowledge and Evaluation Research (KER) Unit, Mayo ClinicPhoebe Family Medicine ResidencyKnowledge and Evaluation Research (KER) Unit, Mayo ClinicKnowledge and Evaluation Research (KER) Unit, Mayo ClinicKnowledge and Evaluation Research (KER) Unit, Mayo ClinicAbstract 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.http://link.springer.com/article/10.1186/s12875-018-0852-0Minimally disruptive medicinePatient capacityElectronic medical recordElectronic health recordTreatment burdenTreatment planning |
spellingShingle | Kasey R Boehmer Maria Kyriacou Emma Behnken Megan Branda Victor M Montori Patient capacity for self-care in the medical record of patients with chronic conditions: a mixed-methods retrospective study BMC Family Practice Minimally disruptive medicine Patient capacity Electronic medical record Electronic health record Treatment burden Treatment planning |
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 | Minimally disruptive medicine Patient capacity Electronic medical record Electronic health record Treatment burden Treatment planning |
url | http://link.springer.com/article/10.1186/s12875-018-0852-0 |
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