Prevalence and identification of problems in daily functioning in a primary medicine clinic

Purpose: This pilot study compares scores on a health status/functional assessment measure to clinician identification of problems in functioning and referrals for these problems, based on examination of information in the patient's medical chart. Method: A sample of 194 participants at a primary medicine clinic in an urban general hospital completed a measure of health status and functioning, the Medical Outcomes Trust Short Form 36 (SF-36). Chart reviews were conducted to assess whether problems in functioning were addressed by the primary care clinician. Results: Overall, levels of functioning on the scales of the SF-36 were well below norms for the general US population from the Medical Outcomes Study. Older adults showed lower physical functioning and higher emotional functioning than younger adults. Participants with 1, 2, or 3 chronic conditions showed increasingly lower levels of physical functioning. For participants with functional assessment scale scores in the lowest quartile, problems in functioning noted in the chart ranged from 13%-28%. Only 6%-20% of participants with marked problems in functioning were referred for further assessment or treatment. Conclusions: Functional problems are frequently important indicators of risk of development of secondary complications and need for referral. Questionnaire screening may increase identification and referral for problems in functioning in primary care settings.