What is the general approach to management in medical practice?

General Approach to Management in Medical Practice

The general approach to management in medical practice should follow a patient-centered framework using a multidisciplinary team-based approach with shared decision-making to improve health outcomes, facilitate risk factor modification, and optimize health service utilization. 1

Core Principles of Medical Management

Patient-Centered Framework

• Management should be guided by a patient-centered framework that considers the patient's needs, preferences, and priorities 1
• Assessment should include understanding the impact of the condition on daily functioning, patient concerns about their condition, perceived control, and expectations for treatment 1
• Establish the patient's functional and valued life goals to determine what they cannot currently do as a result of their condition 1

Comprehensive Assessment

• Assessment should be brief or extensive depending on available time, whether it's a first or regular consultation, and patient needs 1
• Evaluate:
  • Patient's pain characteristics (if applicable): severity, type, spread, quality
  • Previous and ongoing treatments and their perceived efficacy
  • Current disease activity and potential damage
  • Related factors that might need attention (disability, beliefs, social influences, sleep problems, etc.)

Personalized Management Plan

• Develop a personalized treatment plan using shared decision-making 1
• Consider age, additional risk factors, psychological and sociocultural factors, economic status, barriers to adherence, and personal/family values and preferences 1
• Provide clear and salient information in written, diagrammatic, and electronic format that addresses age-related, sociocultural, psychological, language, and health literacy barriers 1

Implementation of Management

Graduated Approach

• Management should take the form of a graduated approach 1
• Focus first on non-pharmacological modalities based on availability, cost, safety issues, and patient preference 1
• Progress to pharmacological therapies when needed, with consideration of risk-benefit balance 1

Team-Based Care

• Implement a multidisciplinary team-based approach to improve outcomes 1
• Team members may include physicians, nurse practitioners, physician assistants, nurses, pharmacists, dietitians, exercise physiologists, therapists, psychologists, and social workers 1
• Continuous communication among the care team, the patient, and caregivers is essential 1

Shared Decision-Making

• Base recommendations on the patient's priorities most compatible with the likely prognosis and available treatment options 2
• Follow a three-step approach to recommendations: 2
  1. Evaluate the prognosis and treatment options
  2. Understand the range of priorities important to the patient given the prognosis
  3. Base recommendations on patient priorities compatible with prognosis and available treatments

Monitoring and Follow-Up

Regular Assessment

• Conduct clinical follow-up evaluation at least annually for stable patients on optimized therapy 1
• Supplement in-person evaluations with telehealth visits when clinically appropriate 1
• Use validated patient-reported disease-specific health status measures to reliably quantify symptom burden 1

Treatment Adjustment

• Systematically identify and address multifactorial barriers to medication adherence 1
• Identify patients not receiving guideline-directed medical therapy and facilitate treatment initiation 1
• Use multiple interventions for improving adherence, including provision of free/subsidized medication, reminders, single-pill combinations, and expanded roles for allied healthcare providers 1

Special Considerations

Transition of Care

• Plan transition of care from pediatric to adult services well in advance 1
• Support patients to facilitate and sustain self-management into adulthood 1

Care Pathways

• Define clear care pathways between general practice and specialist centers 1
• Manage well-controlled and lower-complexity patients in general practice 1
• Refer less well-controlled and higher-complexity patients to specialist centers, with option for shared care with general practice 1

Common Pitfalls to Avoid

• Inaccurate estimation of symptom burden by clinicians, which can lead to under- or overtreatment 1
• Failing to identify and address barriers to medication adherence 1
• Making strong recommendations based on low-certainty evidence without proper justification 3
• Overlooking the importance of non-pharmacological interventions as first-line approaches 1
• Neglecting the psychological and social aspects of patient care 1

By following these principles and implementing a structured, patient-centered approach to management, clinicians can optimize outcomes and provide high-quality care across various medical conditions.