Minimally disruptive medicine (MDM) in clinical practice: a qualitative case study of the human immunodeficiency virus (HIV) clinic care model

Abd Moain Abu Dabrh, Kasey R. Boehmer, Nathan Shippee, Stacey A. Rizza, Adam I. Perlman, Sara R. Dick, Emma M. Behnken, Victor M. Montori

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Recent evidence suggests the need to reframe healthcare delivery for patients with chronic conditions, with emphasis on minimizing healthcare footprint/workload on patients, caregivers, clinicians and health systems through the proposed Minimally Disruptive Medicine (MDM) care model named. HIV care models have evolved to further focus on understanding barriers and facilitators to care delivery while improving patient-centered outcomes (e.g., disease progression, adherence, access, quality of life). It is hypothesized that these models may provide an example of MDM care model in clinic practice. Therefore, this study aimed to observe and ascertain MDM-concordant and discordant elements that may exist within a tertiary-setting HIV clinic care model for patients living with HIV or AIDS (PLWHA). We also aimed to identify lessons learned from this setting to inform improving the feasibility and usefulness of MDM care model. Methods: This qualitative case study occurred in multidisciplinary HIV comprehensive-care clinic within an urban tertiary-medical center. Participants included Adult PLWHA and informal caregivers (e.g. family/friends) attending the clinic for regular appointments were recruited. All clinic staff were eligible for recruitment. Measurements included; semi-guided interviews with patients, caregivers, or both; semi-guided interviews with varied clinicians (individually); and direct observations of clinical encounters (patient-clinicians), as well as staff daily operations in 2015–2017. The qualitative-data synthesis used iterative, mainly inductive thematic coding. Results: Researcher interviews and observations data included 28 patients, 5 caregivers, and 14 care-team members. With few exceptions, the clinic care model elements aligned closely to the MDM model of care through supporting patient capacity/abilities (with some patients receiving minimal social support and limited assistance with reframing their biography) and minimizing workload/demands (with some patients challenged by the clinic hours of operation). Conclusions: The studied HIV clinic incorporated many of the MDM tenants, contributing to its validation, and informing gaps in knowledge. While these findings may support the design and implementation of care that is both minimally disruptive and maximally supportive, the impact of MDM on patient-important outcomes and different care settings require further studying.

Original languageEnglish (US)
Article number24
JournalBMC Health Services Research
Volume21
Issue number1
DOIs
StatePublished - Dec 2021

Bibliographical note

Funding Information:
Our study based on interviews and observations at a single and mature HIV clinic—one following a well-rehearsed approach typical of clinics funded by the Federal Ryan White grants, and the US federal 340B pharmacy program —may offer only a “best-case” scenario. Reports from people available for interview at the clinic may not represent well the views of those who had difficulty attending appointments, thus it may have missed features that failed to support people with limited capacity. Our participating patient sample size, however, provides a comparable socio-demographic representation of the general population seen within the HIV clinic. Additional strengths of our approach also derive from the implementation of a rigorous, inductive, and collaborative approach, using two coders, a shared and mutually established codebook, and regular member check meetings during the analysis process. We expect that our findings will support policy makers, stakeholder, and users of various clinical settings to determine the potential pertinence, applicability, and usability of our findings to their settings.

Publisher Copyright:
© 2021, The Author(s).

Keywords

  • Capacity
  • Cumulative complexity model
  • HIV care
  • Healthcare burden
  • MDM
  • Minimally disruptive medicine
  • Model of care
  • PILLARS
  • Treatment burden
  • Workload

PubMed: MeSH publication types

  • Journal Article

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