Functioning assessment vs. conventional medical assessment: a comparative study on health professionals' clinical decision-making and the fit with patient's own perspective of health

Authors

  • Hillegonda A Stallinga MSc, RN,

    PhD Student, Corresponding author
    1. Wenckebach Institute, School of Nursing & Health, Graduate School for Health Research (SHARE), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
    • Correspondence: Hillegonda A Stallinga, PhD Student, UMCG School of Nursing & Health, Home postal code: FC33, University Medical Center Groningen, PO box 30.001, 9700 RB Groningen, the Netherlands. Telephone +31 503614284.

      E-mail: h.a.stallinga@umcg.nl

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  • Petrie F Roodbol PhD, RN,

    Professor in Nursing
    1. Dean Wenckebach Institute, School of Nursing & Health, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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  • Coby Annema MSc, RN,

    PhD Student
    1. Wenckebach Institute, School of Nursing & Health, Graduate School for Health Research (SHARE), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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  • Gerard J Jansen PhD,

    Lecturer and Researcher
    1. Master Advanced Nursing Practice, Hanze University of Applied Sciences, Groningen, the Netherlands
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  • Klaske Wynia PhD, RN

    Research Scientist in Integrated Care
    1. Department of Neurology, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Abstract

Aims and objectives

To compare a functioning assessment based on the International Classification of Functioning, Disability and Health (ICF) with a conventional medical assessment, in terms of their respective consequences for health professionals' clinical decision-making and the fit with patient's own perspective of health.

Background

In chronic diseases, pathogenic-oriented health care falls short in generating all the information required for determining healthcare provision to improve health. A broader, so-called salutogenic approach, by using the ICF, focusing on how to stay healthy, rather than on what causes diseases, seems more appropriate.

Design

A cross-sectional comparative study using data from a randomised controlled trial.

Methods

Data about patient problems and professional healthcare activities were collected from a total of 81 patients with severe multiple sclerosis who were randomly assigned to one of two groups: the ICF group, assessed with a functioning assessment (n = 43), and the medical group, assessed with a conventional medical assessment (n = 38). Data were analysed statistically using descriptive and inferential statistics.

Results

A functioning assessment resulted in the registration of significantly more patient problems in the health components ‘participation’ and ‘environmental factors’, as well as significantly more professional healthcare activities befitting these components. The ICF group had a significant positive correlation between registered problems by health professionals and patients' self-reported problems, whereas the medical group had several negative correlations.

Conclusion

A functioning assessment resulted in a care plan that not only was broader and more complete but also reflected the patients' self-reported problems more closely than a medical assessment, without a loss of focus on medical problems.

Relevance to clinical practice

This study has shown that some health problems remain unnoticed by a medical assessment alone, which is especially important for the chronically ill. A functioning assessment provides a strong foundation for identifying all relevant information related to health.

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