How is adult patient adherence recorded in orthodontists' clinical notes? A mixed-method case-note study

Background: Patient adherence in orthodontic treatment is extremely important as it is linked with better treatment outcomes. Despite its importance, however, there is no shared definition of the concept. This makes the recording of adherence-related behaviors in patient notes difficult. The current study explored how, and to what extent adherence is recorded in adult patients' medical records by orthodontists working in a large National Health Service (NHS) London hospital. Materials and methods: A mixed-methods approach was used. A total of 17 clinicians with a mean age of 31 years (SD =4.87) provided N=20 case notes spanning N=324 appointments with patients they judged to be non-adherent. The notes were inspected for evidence of recording of patient adherence using adherence indicators identified in the literature. Results: The term "adherence" did not feature in any notes. The quantitative analysis showed that the three most frequent adherence-related behaviors recorded in notes were "oral hygiene," "appointment attendance" and "breakages of appliances." Qualitative analysis not only confirmed these factors but also showed that 1) the clinical aspects of treatment, 2) clinician-patient interaction factors and 3) patient attitudes also featured. This part of the analysis also highlighted inconsistencies across case notes in terms of the amount of information being recorded. Conclusion: Adherence as a term does not feature in the clinical case notes of clinician-identified non-adherent adult patients, while predictors of adherence are recorded with varying degrees of consistency.