Characterizing physical activity documentation patterns and curriculum of Canadian family physicians

• Author / Creator

  Lindeman, Clifford

• Family physicians (FP) can be meaningful advocates to support patients to attain the benefits of physical activity (PA); however, the PA-related documentation FPs make in electronic medical records (EMR) is largely unknown. The purpose of this dissertation was to conduct three studies: to examine the content of PA inputs in FP EMRs, to describe the PA curriculum in family medicine residency programs, and to quantify the association of patient and FP characteristics to PA documentation. Two studies used extracted EMR data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN), which includes ~1,400 sentinel primary care providers from 12 EMR systems and eight provinces. A third study used information from family medicine residency program websites and curriculum experts. Study 1 selected a random sample of 1,535 patients aged 18-64.9 to understand if PA information was documented in their EMRs and to identify the PA status of patients according to PA guidelines. It found that less than one in 10 patients had any PA information in their EMRs. Where PA information was documented, FPs usually recorded that patients were undertaking discretionary/leisure PA or were inactive. Predominantly insufficient information existed to identify whether a patient was active according to PA guidelines. Study 2 investigated the extent that Canadian FM residency programs offered PA training. All responding programs stated they provide PA training to some degree. Most included curriculum related to physical inactivity as a risk factor for chronic conditions and resulting discussions on the benefits derived from being physically active. Curriculum about PA guidelines is variable, and few programs taught residents how to document PA in EMR; only one of the 14 programs indicated that residents learn how to document PA in an EMR pertaining to meeting guidelines. Study 3 used a CPCSSN datacut of 769,185 patients aged 18-64.9 to quantify the association of PA inputs with patient and FP characteristics on a randomly selected encounter date. Of those, 1.9 percent (n = 14,828) of patients had PA documented in their FPs EMR. Older than mean patient age, having fewer comorbidities, younger than mean FP age, academic teach sites, and select EMR systems were statistically significant predictors of PA documentation. In particular, patients visiting academic teaching sites were much more likely to have PA recommendations documented in their records. The findings from this dissertation demonstrate that while most family medicine residency programs provide general training on PA, patient PA is documented infrequently within EMRs.

• Subjects / Keywords

  • Primary care
  • family physicians
  • physical activity
  • electronic medical record

• Graduation date

  Fall 2022

• Type of Item

  Thesis

• Degree

  Doctor of Philosophy

• DOI

  https://doi.org/10.7939/r3-8nvv-7c24

• License

  This thesis is made available by the University of Alberta Library with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.