JMIR Publications

ABSTRACT

Background:

Management of chronic conditions entails numerous activities in both clinical and daily-living settings. Of course, activities across these settings interact, creating a high potential for a gap to occur if there is an inconsistency or disconnect between controlled clinical settings and complex daily-living environments.

Objective:

The purpose of this study was to characterize gaps (from the patient’s perspective) between health-related activities across home-based and clinical settings using anticoagulation treatment as an exemplar. We conceptualized gaps as latent phenomena (i.e., a break in continuity).

Methods:

Patients (n=39) and providers (n=4) from the anticoagulation clinic of an urban, western mountain-based health system were recruited. Data was collected by primary interviews with patients, patient journaling with tablet computers, exit interviews with patients, and provider interviews. Data was analyzed qualitatively based on a theory-driven approach and framework method of analysis.

Results:

The causes of gaps included clinician recommendations not fitting into patient’s daily routines, recommendations not fitting into patients’ living contexts, and information not transferred across settings. The consequences of these gaps included increased cognitive and physical workload on the patient, poor patient satisfaction, and compromised patient adherence. We identified resources and strategies used to overcome these consequences as patient-generated strategies, routines, collaborative management, social environment, and tools and technologies.

Conclusions:

Understanding gaps, their consequences, and mitigating strategies, can lead to the development of interventions that help narrow these gaps. Such interventions could take the form of collaborative health information technologies, novel patient and clinician education initiatives, and programs that strongly integrate health system and community resources. Current technologies are insufficient to narrow the gaps between clinical and daily-living settings (i.e., limited number and types of routines that are tracked).