Annals Journal Club: The Capability Framework
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The *Annals of Family Medicine* encourages readers to develop a learning community of those seeking to improve health care and health through enhanced primary care. You can participate by conducting a RADICAL journal club and sharing the results of your discussions in the Annals online discussion for the featured articles. RADICAL is an acronym for Read, Ask, Discuss, Inquire, Collaborate, Act, and Learn. The word radical also indicates the need to engage diverse participants in thinking critically about important issues affecting primary care and then acting on those discussions.1

## HOW IT WORKS

In each issue, the *Annals* selects an article or articles and provides discussion tips and questions. We encourage you to take a RADICAL approach to these materials and to post a summary of your conversation in our online discussion. (Open the article online and click on “TRACK Comments: Submit a response.”) You can find discussion questions and more information online at: [http://www.AnnFamMed.org/AJC/](http://www.AnnFamMed.org/AJC/).

## CURRENT SELECTION

### Article for Discussion

Ferrer RL, Carrasco AV. Capability and clinical success. *Ann Fam Med.* 2010;8(5):454–460.

### Discussion Tips

This article is different from most *Annals* Journal Club selections. A theory piece, it provides a framework for us to see differently problems that often seem intractable from a narrower clinical perspective.

### Discussion Questions

*   What problem(s) are addressed by this article?

*   How well does the opening case represent challenging patients in your setting? How responsive is your practice to the needs and opportunities presented by such patients?

*   Do the article’s sections on epidemiological context, the disconnect between process and outcome improvements, and environmental barriers to healthy behaviors bring to mind shortcomings of your practice or health care system situation?

*   How well does the capability framework reflect your life and clinical experience? Does this framework help you to see avenues to work on problems that previously seemed outside the bounds of your vision or clinical competence?

*   How well grounded in literature or experience does this theory appear, as articulated in the article?

*   What holes do you see in this framework?

*   What are the implications of the framework for patient-centered care?

*   Can you use Tables 1 and 2 to apply the framework to improve your care of a challenging patient you have seen this week?

*   How might you develop practice systems and community partnerships to support application of the capability framework? What support already exists where you are?

*   What policy implications are suggested by this theory?

*   What research opportunities does this theory suggest? How might a participatory research approach2 be used to pursue these opportunities?

*   © 2010 Annals of Family Medicine, Inc.

## REFERENCES

1.  Stange KC, Miller WL, McLellan LA, et al. *Annals* Journal Club: It’s time to get RADICAL. Ann Fam Med. 2006;4(3):196–197. [http://annfammed.org/cgi/content/full/4/3/196](http://annfammed.org/cgi/content/full/4/3/196).
    
    [FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiNC8zLzE5NiI7czo0OiJhdG9tIjtzOjIyOiIvYW5uYWxzZm0vOC81L2lpaS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

2.  Macaulay AC, Commanda LE, Freeman WL, et al. North American Primary Care Research Group. Participatory research maximises community and lay involvement. BMJ. 1999;319(7212):774–778.
    
    [FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6MzoiYm1qIjtzOjU6InJlc2lkIjtzOjEyOiIzMTkvNzIxMi83NzQiO3M6NDoiYXRvbSI7czoyMjoiL2FubmFsc2ZtLzgvNS9paWkuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9)