Reducing the burden of treatment in patients with chronic conditions by enhancing capacity. A new tool

Our friends at Mayo Clinic’s Center for Innovation are working hard at developing assessments of capacity for patients.  This is particularly important – and why they are working with our team – when we want to reduce the burden of treatment, the result of healthcare demands exceeding the capacity to access, use, and enact healthcare that affects overwhelmed patients with multiple chronic conditions.  

In minimally disruptive medicine, the healthcare system should partner with patients, caregivers, and the community to manage the workload/capacity balance.  One way that this balance can be restored is by reducing treatment burden, i.e., workload. Another one, is to enhance the capacity to face those demands.  This requires support for patients and caregivers.  Some of that support may come from enhancing community support.  

The CFI team has developed these tools.  What do you think?  Could something like this be helpful as part of a ‘goldilocks’ dashboard?

Independence at Home Organizations as implementors of Goldilocks care?

The New York Times offers an OpEd written by Jack Resnick, a NYC solo internist. In this article, Dr, Resnick discusses delivering care at home and highlights the health and economic opportunities afforded by this practice, particularly among the elderly and highly disabled. Of course, these patient groups are often complex and have multiple comorbidities.

The opportunity afforded clinicians who assess patients at home is that of a highly detailed understanding of the context in which caregiving (including self-care) is taking place and on the ways care is being implemented.

A colleague working a few years back in the Peruvian jungle noted that pill blisters were accumulating around a religious icon sitting on a shelf. The patient felt that this was the way in which these medicines would be most conducive to improved her health.

Clinicians accessing patients at home also reduce access barriers to care and can make care delivery fit the context of these patients and their caregivers. By clinicians I mean not only physicians but also nurses, pharmacists, social workers, dietitians, coaches, and other healthcare workers. 

As consultants and sales people know, travelling to make sure you have enough face-to-face contact is important to develop relationships and make fruitful connection. Chronic care delivery clinicians know the same thing. As both are finding out, tools to achieve that connection cannot replace the power of the personal visit, but certainly supplement it. To make models of home care affordable will require a combination of in-person and technology enabled contacts, with the former always administered in sufficient dose before shifting to the latter.

Healthcare reform in the US has provisions to support Independence at Home Organizations. Very little research into technologies to support home care delivery and in ways to support and enable the informal care network that is home-based exists. It would be critical when developing rules for these organizations that the burden they may impose on patients and caregivers be kept to a minimum by design, that they connect with communities to improve patient and caregiver capacity, and that they proceed efficiently in a patient-centered fashion.

That this connects with Minimally Disruptive Medicine is hinted by Dr. Resnick himself, the author of the OpEd.  He states:

For too long the institutions that make up our health care system — hospitals, insurers and drug companies — have told us that “more is better”: more medicines, more specialists, more tests. To rein in spending and deliver better care, we must recognize that the primary mission of many an institution is its own survival and growth. We can’t rely on institutions to shrink themselves. We need to give that job to patients and their doctors, and move health care into the home, where it is safer and more effective.

Perhaps too much to ask of a single solution set, but perhaps not. For those who are home bound and for those for whom the current system fails them by overwhelming them, home delivered care may represent one more tool to deliver care that fits. 

The Atlantic publishes a model of minimally disruptive medicine that works efficiently!

The Atlantic magazine published an article entitled The Quite Health-care Revolution that essentially reports on a successful implementation of minimally disruptive medicine, with a twist: it lowered costs!  Read and comment.

Farmacia minimamente impertinente

Desde La Sala de Lectura, el muy recomendable blog del Rincón de Sísifo, viene un primer eco a la presentación sobre Medicina Minimamente Impertinente que dimos en el congreso nacional de farmacéuticos de atención primaria en Bilbao.  Fue un gran placer presentar en esta ocasión y disfrutar luego de los comentarios en twitter y en este blog sobre lo que podría ser.  Gracias por soñar con nosotros.

Medicina minimamente impertinente

Here is the video of my presentation in Spanish about MDM at the National Meeting of Primary Care Pharmacists in Bilbao, Spain in October 2011.

Aqui esta el video de mi presentación en español sobre Medicina Minimamente Impertinente en el Congreso Nacional de Farmacéuticos de Atención Primaria en Bilbao, España en octubre 2011.

http://www.irekia.euskadi.net/video/flowplayer-3.2.4.swf

Fuente: Irekia – Gobierno Vasco

Tailoring treatments to patient capacity

In a provocative piece, Slate magazine’s Darshak Sanghavi writes about “tiered medicine” and proposes that clinical protocols be titrated to patient capacity.  This again approaches the notion of “Goldilocks” medicine we spouse in Minimally Disruptive Medicine. We have also discussed the need to have guidelines that appreciate this issue and that perhaps efficacy may need to have a secondary priority, particularly among patients who are overwhelmed with multiple chronic conditions.

Follow minimally disruptive medicine on twitter

Let’s use the hashtag #minidm to tag posts about minimally disruptive medicine.

Thus to review recent posts in twitter on minimally disruptive medicine you can click here