Minimally Disruptive Medicine

We just received great news!

The MDM team, led by Frances Mair just got awarded a grant from Chief Scientist Office of Scotland to conduct the project “Developing a conceptual model of the burden of treatment and the “work” involved in living with heart failure”. Other investigators mentioned in the award include Carl May and Victor Montori.

Here is the project summary:

This project grant is the first in a program of research developing the “Minimally Disruptive Medicine (MDM)” research agenda.  Poor adherence to treatment regimens and lifestyle advice may lead to an additional burden of poor health for chronic heart failure (CHF) patients, their families and the health service.  Non-adherence is often regarded as a problem of individual volition or about lack of patient understanding. However, CHF patients often have multiple co-morbidities – and generally face an increasing burden of work in managing their conditions. This work includes complex pharmaceutical regimes, frequent clinic attendances, lifestyle changes and self care responsibilities.

As this treatment burden grows, patients find it difficult to meet the demands placed on them. In this project we aim to identify, describe, and explain the work involved in living with CHF, through analysis of both archived and new CHF patient perception interviews.  We aim to develop a robust conceptual model of CHF work in order to inform the development of new points (and forms) of clinical intervention.

Here we go!

Focusing on the patients’ experience of treatment may lead to a new understanding as to why some patients cannot, despite their willingness and knowledge, follow treatment recommendations.  Our team is exploring the aspects of treatments that may constitute treatment burden.  Do you have some ideas?

For instance, in the United States, patients may need to spend time on the phone, sending letters and faxes, and waiting for responses to obtain new medications, refill other ones, and deal with denials of coverage by their insurer.

Are there ways in which the healthcare professionals can help patients by providing adequate assistance and by modifying the regimen to minimize this form of treatment burden?  How would they know if they have been successful?  Who are the professionals best suited for this work?  Social workers, pharmacists, lifestyle coaches, nurses, and physicians working in teams alongside the patient and their caregivers?  Utopia?  No, we think this is reality just around the corner.  Can minimally disruptive medicine teams positively improve the value of healthcare delivery?  What are your thoughts?

One very astute opinion leader, Gary Oftedahl, is finding this compelling.  Read his blog here.  He notes:

If we in health care are unable to make simple changes in workflows or processes within our care delivery systems, how can we expect our patients to make often complex, and complicated changes, which disrupt a life-long pattern of activity?

What do you think?

We had the opportunity to present on Minimally Disruptive Medicine at the Innovation Symposium (Transform) at Mayo Clinic on September 14 2009.  The video of the presentation by Victor Montori is here (scroll down to find it). 

Another member of our team had an AWESOME presentation as well — in fact the majority of the presentations of this symposium brilliantly organized and conducted by David Rosenman, my friend and colleague, were incredibly good and illuminating.   Maggie Breslin closed the symposium with a passionate call for meaningful conversations in healthcare.  Plain true and brilliant.  You can find that video at the same website.

Enjoy!

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

When discussing who is at risk of being burdened by treatments, we have come up with a list…we are wondering what other groups people can think of:

• Individuals with limited familial or social support
• Individuals with poor overall or health literacy
• Individuals with many chronic conditions
• Individuals with treatments that require constant attention, e.g., implanted devices that call attention to themselves throughout the day, pills that need to be taken several times per day
• Individuals who travel far for healthcare
• Individuals who have to wait for healthcare: to park, in line, at the office
• Individuals who have tenuous health insurance who need to spend time arguing with insurance

Who else is in your list?

Here is a long video of the presentation to the community in Rochester Minnesota related to Minimally Disruptive Medicine.

See the Mayo Clinic news blog account of our paper in the BMJ with a video interview with Victor Montori.

That video is also below