Schattner Peter, Barker Fiona, de Lusignan Simon
Associate Professor Department of General Practice School of Primary Health Care Monash University MELBOURNE.
J Innov Health Inform. 2015 Feb 19;22(1):250-4. doi: 10.14236/jhi.v22i1.136.
Minimally disruptive medicine (MDM) is proposed as a method for more appropriately managing people with multiple chronic disease. Much clinical management is currently single disease focussed, with people with multimorbidity being managed according to multiple single disease guidelines. Current initiatives to improve care include education about individual conditions and creating an environment where multiple guidelines might be simultaneously supported. The patient-centred medical home (PCMH) is an example of the latter. However, educational programmes and PCMH may increase the burden on patients.
The cumulative workload for patients in managing the impact of multiple disease-specific guidelines is only relatively recently recognised. There is an intellectual vacuum as to how best to manage multimorbidity and how informatics might support implementing MDM. There is currently no alternative to multiple single-condition- specific guidelines and a lack of certainty, should the treatment burden need to be reduced, as to which guideline might be 'dropped'.
The best information about multimorbidity is recorded in primary care computerised medical record (CMR) systems and in an increasing number of integrated care organisations. CMR systems have the potential to flag individuals who might be in greatest need. However, CMR systems may also provide insights into whether there are ameliorating factors that might make it easier for them to be resilient to the burden of care. Data from such CMR systems might be used to develop the evidence base about how to better manage multimorbidity.
There is potential for these information systems to help reduce the management burden on patients and clinicians. However, substantial investment in research-driven CMR development is needed if we are to achieve this.
微创医学（MDM）被提议作为一种更适当地管理患有多种慢性病患者的方法。目前许多临床管理都聚焦于单一疾病，患有多种疾病的患者是根据多个单一疾病指南进行管理的。当前改善护理的举措包括针对个体病情的教育以及营造一个可能同时支持多个指南的环境。以患者为中心的医疗之家（PCMH）就是后者中的一个例子。然而，教育项目和PCMH可能会增加患者的负担。
患者在应对多种疾病特定指南影响方面的累积工作量直到最近才得到相对认可。关于如何最好地管理多种疾病以及信息学如何支持实施微创医学，存在知识空白。目前除了多个针对单一病症的特定指南外别无选择，而且在需要减轻治疗负担时，对于应该“舍弃”哪个指南缺乏确定性。
关于多种疾病的最佳信息记录在初级保健计算机化病历（CMR）系统以及越来越多的综合护理组织中。CMR系统有潜力标记出最需要的个体。然而，CMR系统也可能提供关于是否存在改善因素的见解，这些因素可能使他们更容易承受护理负担。来自此类CMR系统的数据可用于建立关于如何更好地管理多种疾病的证据基础。
这些信息系统有潜力帮助减轻患者和临床医生的管理负担。然而，如果我们要实现这一点，就需要对研究驱动的CMR开发进行大量投资。
