BackgroundShared medical appointments (SMAs) are doctor-patient visits in which groups of patients are seen by one or more health care providers in a concurrent session. There is a growing interest in understanding the potential benefits of SMAs in various contexts to improve clinical outcomes and reduce healthcare costs. This study builds upon the existing evidence base that suggests SMAs are indeed effective. In this study, we explored how they are effective in terms of the underlying mechanisms of action and under what circumstances.MethodsRealist review methodology was used to synthesize the literature on SMAs, which included a broad search of 800+ published articles. 71 high quality primary research articles were retained to build a conceptual model of SMAs and 20 of those were selected for an in depth analysis using realist methodology (i.e.,middle-range theories and and context-mechanism-outcome configurations).ResultsNine main mechanisms that serve to explain how SMAs work were theorized from the data immersion process and configured in a series of context-mechanism-outcome configurations (CMOs). These are: (1) Group exposure in SMAs combats isolation, which in turn helps to remove doubts about one’s ability to manage illness; (2) Patients learn about disease self-management vicariously by witnessing others’ illness experiences; (3) Patients feel inspired by seeing others who are coping well; (4) Group dynamics lead patients and providers to developing more equitable relationships; (5) Providers feel increased appreciation and rapport toward colleagues leading to increased efficiency; (6) Providers learn from the patients how better to meet their patients’ needs; (7) Adequate time allotment of the SMA leads patients to feel supported; (8) Patients receive professional expertise from the provider in combination with first-hand information from peers, resulting in more robust health knowledge; and (9) Patients have the opportunity to see how the physicians interact with fellow patients, which allows them to get to know the physician and better determine their level of trust.ConclusionsNine overarching mechanisms were configured in CMO configurations and discussed as a set of complementary middle-range programme theories to explain how SMAs work. It is anticipated that this innovative work in theorizing SMAs using realist review methodology will provide policy makers and SMA program planners adequate conceptual grounding to design contextually sensitive SMA programs in a wide variety of settings and advance an SMA research agenda for varied contexts.

College health professionals should recognize and address the mental health needs of bisexual and lesbian undergraduate college women.

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Introduction. Perfectionism consists of high standards and hypercritical selfevaluation. Some doctor of physical therapy (DPT) students experience increased stress levels due to rigorous academic expectations. ere is limited understanding of how successful these students are at managing increased stress, especially among perfectionists. e purpose was to examine perfectionism among entry-level DPT students and its relationship to perceived stress. Review of Literature. Researchers have studied perfectionism and stress in health professions programs, but not DPT programs. Being a Maladaptive Perfectionist (MP) was positively and strongly associated with stress among health professions students. Subjects. Convenience sample of firstyear, second-year, and third-year DPT students (n = 163). Methods. is was a nonexperimental, single-site, cross-sectional study. Investigators used 3-way analysis of variance to compare student characteristics and binomial logistic regressions to determine whether characteristic and/or perceived stress was predictive of perfectionism subtype. ey completed bivariate correlations to determine associations between perfectionism and stress. Results. Sample results demonstrated 41.10% Adaptive Perfectionists and 25.15% MPs. ere was a moderate, direct association between perceived stress and the perfectionism discrepancy measure (r s = .51, P < .01). e perceived stress and perfectionism subtype logistic regression model was statistically significant, x 2 (1) = 18.73, P < .01. Participants with increased perceived stress had 1.17 times higher odds of being categorized as an MP than those with lower stress levels. Discussion and Conclusion. Maladaptive Perfectionist students may be at greater risk for stress-related issues. Perfectionism and stress measures may assist educators in identifying at-risk students, monitor student response to stress management interventions, and consider curricular changes to lower stress. Students who effectively manage stress may ultimately have overall greater well-being.