Healing Tool Series: Minimally Disruptive Medicine

A theory-based approach to care for complex patients focused on a patient’s life and health goals and providing the smallest treatment burden that is effective

“Healing Tools” summaries are a collection of evidence-based resources to help providers and patients use integrative health approaches to improve health and wellbeing.

This tool is for: Providers 

This tool was created by: Knowledge and Evaluation Research Unit at Mayo Clinic

SUMMARY

What is this tool for?

Healthcare resources in the United States are increasingly being used for complex patients with multiple chronic conditions.[i] Yet the results of efforts to address the unique challenges of caring for these patients have been mixed.

Minimally disruptive medicine (MDM) is a patient-centered, context-sensitive approach to care for patients with multiple chronic conditions. It focuses on achieving patient goals for life and health while imposing the smallest possible treatment burden on patients’ lives.

MDM aims to address all factors that impact the implementation and effectiveness of care for patients with multiple chronic conditions. This often requires adjusting protocols and practice guidelines to fit the needs and desires of patients and their complicated lives, needs and preferences.

Two key strategies form the basis of MDM:

  1. Identifying the right care: truly useful and needed care that is feasible for the patient
  2. Making the right care happen

Sample tools for practicing MDM

Tools for identifying the right care include:

  • Goal-elicitation: establishing the patient’s life goals and entering them into the medical record for use in orienting care.
  • Shared decision-making: incorporating patient values and preferences into management decisions, legitimizing the partnership, and determining feasible care strategies.
  • Patient-reported outcome tracking: standardizing ongoing recording of health status, life and health burdens, and changes in support.

Tools for making the right care happen include:

  • Lean consumption: directing efforts of healthcare providers to improve efficiency from the patient’s perspective (e.g., shorter wait times).
  • Medication therapy management: optimizing medication regimens to patient needs, desires and circumstances, including deprescribing low-value and burdensome medications.
  • Community navigators: connecting patients to community resources.

Tools and resources on the minimally disruptive medicine website

Free tools and resources include:

Journal article: Leppin AL, Montori VM, Gionfriddo MR. “Minimally Disruptive Medicine: A Pragmatically Comprehensive Model for Delivering Care to Patients with Multiple Chronic Conditions.” Healthcare 2015, 3(1), 50-63; doi:10.3390/healthcare3010050.

An overview of MDM, with a table of tools to identify the right care and make the right care happen.

The Instrument for Patient Capacity Assessment (ICAN): ICAN is a discussion aid for clinical encounters to help patients and providers discuss areas of the patient’s life and issues in treatment.

This web page includes:

  • Clinician card
  • Patient card
  • A guide for introducing ICAN to patients
  • Instructions for using ICAN
  • Videos illustrating the use of ICAN

Deprescribing tools: Deprescribing is optimizing medication by reducing or stopping prescription of drugs that are no longer needed to manage chronic conditions, avoid adverse effects, and improve outcomes.[iv]

This web page includes links to external resources:

  • MedStopper: A tool to help clinicians and patients make decisions about reducing or stopping medications.
  • org: Information about deprescribing approaches, research and resources, including:
  • Guidelines and algorithms
  • Patient decision aids

Blog: Articles, papers, presentations and reference materials about MDM in practice, including:

  • Reflections
  • Research
  • Views from the frontline on care

The Patient Revolution

Like the minimally disruptive medicine website, the Patient Revolution is a program of the Mayo Clinic’s Knowledge and Evaluation Research Unit.

The Patient Revolution provides free resources to help patients build skills and confidence to tell their stories to their doctors so that doctors understand their patients’:

  • Lives, including capabilities and limitations
  • Feelings about risks, benefits and trade-offs of care options. ­­­­­­

It is based on the idea that these stories will empower patients, caregivers, community advocates, clinicians and others to rebuild the U.S. healthcare system to provide careful and kind care. Why We Revolt, by Victor Montori, MD, MSc, at the Knowledge and Evaluation Research Unit:

  • Describes what’s wrong with industrial healthcare and how it has stopped caring
  • Proposes a revolution of compassion and solidarity, unhurried conversations, and careful and kind care.

How can providers use this tool?
Providers who are considering or already using this approach will find valuable information on the minimally disruptive medicine website that can aid them in helping patients achieve their goals with the least treatment burden on their lives.

How does this contribute to an integrative health approach?
Integrative health involves combining conventional medicine, self-care, and complementary and alternative medicine to help patients achieve optimal healing, health and wellbeing. MDM involves patients and doctors working together to focus on patients’ goals for their life and health while imposing the smallest possible treatment burden on patients’ lives.

Comparison to the HOPE Note
MDM has similarities to the integrative health approach developed in a Healing Oriented Practice and Environments (HOPE) Visit. Like MDM, HOPE focuses on what matters for the patient, incorporates patient empowerment tools and behavior change support and seeks to provide evidence based tools that patients can do themselves. In addition, HOPE adds specific questions on lifestyle, the patient’s physical and social environment and includes health coaching as a key element.

Click here for further information on the HOPE Note.

What does the evidence say about this tool?

The MDM approach is theory based. It has not been tested. Many of the tools used in minimally disruptive medicine are supported by evidence, when tested in isolation.[v] Whether these tools have synergistic value when used together as part of a minimally disruptive medicine approach is unknown. Further study is necessary.

Evidence for ICAN

ICAN, one of the tools on the minimally disruptive medicine website, was developed using a rigorous, user-centered design process that included observations and prototyping in different settings with a variety of providers. ICAN’s design is supported by a systematic review of the qualitative literature on the experiences of patients who struggled to access and use healthcare or enact self-care.

What are the drawbacks to using this tool?

MDM often requires adjusting protocols and practice guidelines to patients’ needs and desires. Since it is a new approach to care, it takes more time to apply than conventional medical care.

Currently, there are challenges for paying for doing MDM in most practices.

Who created this tool?

The Knowledge and Evaluation Research Unit at Mayo Clinic advances evidence-based patient-centered care for people living with chronic conditions through research. Victor Montori, MD, MSc, directs the unit. He is a professor of medicine, a highly cited researcher, and a diabetes doctor at Mayo Clinic.

[i] Anderson GF. “Chronic Care: Making the Case for Ongoing Care.” Robert Wood Johnson Foundation: Princeton, NJ: 2010.

[ii] Smith, S.M.; Soubhi, H.; Fortin, M.; Hudon, C.; O’Dowd, T. “Interventions for improving outcomes in patients with multimorbidity in primary care and community settings.” Cochrane Database Syst. Rev. 2012, 4. CD006560.

[iii] Leppin AL, Montori VM, Gionfriddo MR. “Minimally Disruptive Medicine: A Pragmatically Comprehensive Model for Delivering Care to Patients with Multiple Chronic Conditions.” Healthcare 2015, 3(1), 50-63; doi:10.3390/healthcare3010050.

[iv] Deprescribing.org. Accessed 1/29/18.

[v] Leppin AL, Montori VM, Gionfriddo MR. “Minimally Disruptive Medicine: A Pragmatically Comprehensive Model for Delivering Care to Patients with Multiple Chronic Conditions.” Healthcare 2015, 3(1), 50-63; doi:10.3390/healthcare3010050.

[vi] Boehmer KR, Hargraves IG, Allen SV, et al. “Meaningful conversations in living with and treating chronic conditions: development of the ICAN discussion aid.” BMC Health Services Research. 2016:16:514 DOI 10.1186/s12913-016-1742-6.

[vii] Boehmer KR, Gionfriddo MR, Rodriguez-Gutierre R, et al.1 “Patient capacity and constraints in the experience of chronic disease: a qualitative systematic review and thematic synthesis.” BMC Family Practice. 2016:17:127 DOI 10.1186/s12875-016-0525-9.


ABOUT THESE INTEGRATIVE HEALTH TOOLS

At Samueli Integrative Health Programs, we believe that achieving optimal health and wellbeing requires an integrative health approach—one that combines and coordinates conventional medicine, self-care, and complementary and alternative medicine.

Translating Evidence into Action

The goal of these summaries is to help providers and patients learn about and access evidence-based integrative health tools. Each featured tool has been vetted by Samueli Integrative Health Programs. Read about more Healing Tools.

Disclosures:

Samueli Integrative Health Programs is a public service of H&S Ventures and does not profit from any of the tools featured in these summaries.

 Patients: Contact your provider before starting any new health program.  Show him/her these resources.