Department of Family Medicine, Mayo Clinic Florida, 4500 San Pablo Rd S, Jacksonville, FL, USA.
Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA.
BMC Health Serv Res. 2021 Jan 6;21(1):24. doi: 10.1186/s12913-020-06010-x.
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.
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.
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).
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.
最近的证据表明，需要重新构建慢性病患者的医疗服务模式，强调通过拟议的最小化医疗干扰（MDM）护理模式，最大限度地减少医疗足迹/工作量对患者、护理人员、临床医生和医疗系统的影响。该模式命名为最小化医疗干扰（MDM）护理模式。艾滋病毒护理模式已经发展到进一步关注理解护理提供的障碍和促进因素，同时改善以患者为中心的结果（例如，疾病进展、依从性、获得、生活质量）。假设这些模型可能为临床实践中的 MDM 护理模式提供范例。因此，本研究旨在观察和确定在为艾滋病毒/艾滋病（PLWHA）患者提供的三级设置艾滋病毒诊所护理模式中可能存在的 MDM 一致和不一致的因素。我们还旨在从该环境中吸取经验教训，为改善 MDM 护理模式的可行性和实用性提供信息。
本定性案例研究发生在城市三级医疗中心的多学科艾滋病毒综合护理诊所内。参与者包括定期就诊的成年 PLWHA 和非正规护理人员（例如，家庭/朋友）。所有临床医生都有资格参加招聘。测量包括：对患者、护理人员或两者进行半引导访谈；对不同临床医生（单独）进行半引导访谈；以及对临床医生与患者的临床接触（患者-临床医生）以及 2015-2017 年期间工作人员的日常运营进行直接观察。使用迭代的、主要是归纳主题编码进行定性数据综合。
研究人员的访谈和观察数据包括 28 名患者、5 名护理人员和 14 名护理团队成员。除了少数例外，诊所护理模式元素与 MDM 护理模式非常吻合，通过支持患者能力（一些患者接受的社会支持很少，在重新构建他们的传记方面的帮助有限）和最小化工作量/需求（一些患者面临诊所的运营时间挑战）。
研究中的艾滋病毒诊所采用了许多 MDM 租户，这验证了该模式，并为知识空白提供了信息。虽然这些发现可能支持设计和实施最小化干扰和最大程度支持的护理，但 MDM 对患者重要结果和不同护理环境的影响需要进一步研究。
