Who Experiences the Most Burdens in Health Care?

What you need to know

• Patients with major depressive disorder reported the highest number of overall burdens in healthcare
• Younger patients with depression (under 38 years old) reported the most personal burdens
• A body mass index (BMI) of 26 or higher was associated with increased healthcare-related burdens
• The ICAN Discussion Aid helps identify patient burdens and can improve care planning

Understanding patient burdens in healthcare

Living with chronic health conditions often requires significant effort from patients. They may need to attend numerous medical appointments, monitor their symptoms, take medications, and make lifestyle changes. All of this “health work” comes on top of managing daily life responsibilities and coping with symptoms. When the demands of healthcare become overwhelming, patients may struggle to keep up, potentially leading to poorer health outcomes.

To address this issue, researchers developed a tool called the ICAN Discussion Aid. ICAN stands for “Instrument for Patient Capacity Assessment.” This tool helps patients and healthcare providers have meaningful conversations about how healthcare fits into a patient’s life. It allows patients to identify areas of their life, including healthcare tasks, that are sources of burden or satisfaction.

While the ICAN Discussion Aid can be useful for many patients, healthcare systems with limited resources may need to prioritize its use for those most likely to benefit. A recent study aimed to identify which patient characteristics are associated with reporting more burdens on the ICAN tool. This information could help target the use of ICAN to patients who may need it most.

How the study was conducted

Researchers analyzed data from 635 adult patients who completed the ICAN Discussion Aid at a family medicine clinic in Arizona. They looked at various patient characteristics, including:

• Age
• Gender
• Body mass index (BMI)
• Chronic health conditions (e.g., depression, anxiety, diabetes, heart disease)
• Number and types of medications

The team then used statistical methods to create models predicting which factors were most strongly associated with patients reporting a higher number of burdens on the ICAN tool.

Key findings: Who reports the most burdens?

Depression and overall burdens

The study found that patients diagnosed with major depressive disorder (MDD) reported the highest number of overall burdens. On average, patients with depression reported 3.3 burdens, compared to 1.6 burdens for patients without depression.

This finding aligns with what we know about depression. The condition can make everyday tasks feel more challenging and drain a person’s energy and motivation. When you add the demands of managing healthcare on top of that, it’s understandable why these patients might feel particularly burdened.

Age and personal burdens

Interestingly, the combination of depression and younger age was associated with reporting even more burdens. Patients with major depression who were younger than 38 years old reported an average of 4.6 personal burdens. This was 3.5 times higher than the average for the entire study group (1.3 personal burdens).

There are several potential reasons why younger adults with depression might experience more personal burdens:

1. They may be juggling multiple responsibilities like establishing careers, raising families, and managing finances.
2. They might have less experience coping with health challenges.
3. There could be a greater perceived stigma around mental health issues for younger adults.

It’s important to note that this group of young adults with depression made up only 2% of the study sample, so more research is needed to confirm these findings.

Body Mass Index (BMI) and healthcare burdens

The study found that a higher BMI was strongly associated with reporting more healthcare-related burdens. Patients with a BMI of 26 or greater reported an average of 0.89 healthcare burdens, compared to 0.37 burdens for those with a BMI below 26.

BMI is a measure that uses height and weight to estimate body fat. A BMI of 25 or higher is generally considered overweight, while 30 or higher is considered obese. The increased healthcare burdens associated with higher BMI could be related to:

• More frequent medical appointments
• Additional health screenings
• Management of weight-related health conditions (e.g., diabetes, high blood pressure)
• Challenges with physical activity or dietary changes

Other factors

While depression, age, and BMI were the strongest predictors of reported burdens, the study identified other factors that may play a role:

• Generalized anxiety disorder
• Number of prescription medications
• Presence of other chronic conditions (e.g., high blood pressure, high cholesterol)

How can this information be used?

The findings from this study can help healthcare providers identify patients who might benefit most from using the ICAN Discussion Aid. By recognizing that certain groups of patients are likely to experience more burdens, healthcare teams can:

1. Prioritize in-depth conversations with these patients about how healthcare fits into their lives
2. Develop more personalized care plans that take into account a patient’s specific challenges and resources
3. Connect patients with additional support services (e.g., mental health resources, social workers, dietitians) as needed
4. Monitor these patients more closely for signs that they might be struggling to keep up with their healthcare tasks

It’s important to remember that while these characteristics can help identify patients who might need extra support, every person’s experience is unique. The ICAN Discussion Aid remains a valuable tool for having patient-centered conversations with a wide range of individuals.

Limitations and future research

This study provides valuable insights, but it does have some limitations:

• It was conducted at a single clinic with patients from one healthcare provider, which may limit how widely the results can be applied.
• The study relied on medical records to estimate patient characteristics at the time they completed the ICAN tool, which may not always be accurate.
• The focus was on chronic medical conditions of interest to the researchers, rather than a standardized list of chronic conditions.

Future research could address these limitations by:

• Studying ICAN use across multiple healthcare settings and with diverse patient populations
• Incorporating the ICAN tool directly into electronic health records for more accurate data collection
• Exploring how ICAN discussions impact patient outcomes over time

Conclusions

• Patients with major depressive disorder, especially those under 38, reported the highest number of burdens on the ICAN Discussion Aid.
• A higher BMI was associated with more healthcare-related burdens.
• These findings can help healthcare providers identify patients who might benefit most from in-depth conversations about how to make healthcare fit better into their lives.
• While certain characteristics are associated with more reported burdens, it’s important to remember that each patient’s experience is unique.
• The ICAN Discussion Aid remains a valuable tool for improving patient-centered care and ensuring that treatment plans are realistic and manageable for patients.