Exploring Capability as a Focus of Intervention in Primary care

Ferrer, Robert Louis; Gonzalez Schlenker, Carolina; Cruz, Inez (2016). 'Exploring Capability as a Focus of Intervention in Primary care' Paper presented at the annual conference of the HDCA, Tokyo 2016.

Background: The Capability Approach has the potential to inform health care in several important respects; first, as an evaluation tool to assess equitable outcomes; second, to better engage patients by considering and developing their capabilities; third, to guide interventions to enhance capability in important domains. In this multiyear project designed to improve outcomes for disadvantaged patients with diabetes in an urban safety-net clinic we have begun to measure practical opportunities and functionings in domains not typically considered in health care settings, including practical oppotunities for healthy diet and activity, and selected functioning and activities and participation codes from the International Classificaiton of Functioning (ICF). These measures are used to guide individualized home and clinic-based interventions, as well as to arrange needed partnerships with community agencies for support in areas such as housing and food.
Methods: The poster will report on 3 years of experience with over 400 patients. We will present descriptive statistics on the prevalence of newly created, validated measures of practical opportunities for healthy behavior. We will also present data on patients' health aspirations and their ratings on a set of ICF activity and participation codes. Lastly we will present preliminary data on the relationship between these non-traditional patient measures and patient outcomes such as control of diabetes and hospitalizations.
Results: Patients selected for the program based on poor control of diabetes demonstrate multidimensional impairments across ICF activity and participation codes, including (among others) self-care, making plans, carrying out tasks, basic economic transactions, and public entitlements. Many also score poorly on measures of practical opportunities for healthy behaviors. When engaged, patients are able to consider thier trajectories on resources and conversion factors.
Discussion: Non-traditional patient assessments informed by the Capability Approach reveal important domains of capability and functioning that are poorly addressed with current models. The assessments point to areas where interventions could be made more effective, efficient, and compassionate. In a larger frame, the results also highlight sources of inequities in the outcomes of health care.

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