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Table 2 Overlap between MDM Model of Care and HIV Clinic Care

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

 

(+)α HIV Clinic model & (−)β MDM

(+) HIV Clinic model & (+) MDM

(−) HIV Clinic model & (+) MDM

Workload

Sense-making

 

• Patient education on purposes for medication/adherence to medication

• Tailored sense-making support

Enrolling/

Planning

 

• Coordinated, team-based care

• Coaching to build patient capacity for self-care

Enacting Work

• Adherence stressed in all sessions due to dire consequences of non-adherence

• Coordinated, team-based care

• Medication burden recognized and supported

• Person-centered scheduling for all care*

Appraisal

 

• Consistent feedback regarding viral load/success of treatment plan

 

Capacity

Biography/living life

• Unique focus on mental health/substance abuse

• Privacy mechanisms

 

• Support during biographical disruption from illness

Resources

 

• Advocate for additional services

 

Environment

• Professionalism, Trust

• Positive Healthcare Environment

• Coordinated, team-based care

• Continuity of coordinated care

• Entire team focused on workload/capacity

Work

• Team members co-location

• Additional services (such as home health) arranged for high-need cases

• Coaching to build patient capacity for self-care

Social

 

• Social support assessed by a social worker

• Stigma minimized

• Social support system understood by all clinicians

• Social network support offered as part of care (e.g., patient groups, community resources)

Other

 

• Attention to clinician workload**

• Manageable case load

  
  1. α (+) = present in
  2. β (−) = absent from
  3. * Although this appeared in the HIV clinic, it was recognizably inconsistent and varied between staff members
  4. ** Recently, the work of MDM has recognized that understanding clinicians’ capacity and workload are also essential components of delivering a minimally disruptive care; thus, there is a need to assess and address that