Group visits for rheumatoid arthritis patients: a pilot study

Shojania, Kam; Ratzlaff, Matthew

doi:10.1007/s10067-010-1379-5

Cited by 15 publications

(10 citation statements)

References 3 publications

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“… L Kawasaki L et al [ 39 ] Willingness to attend group visits for hypertension treatment. M Shojania K, Ratzlaff M. [ 54 ] Group visits for rheumatoid arthritis patients: a pilot study. N Bray P et al [ 14 ].…”

Section: Methodsmentioning

confidence: 99%

A realist review of shared medical appointments: How, for whom, and under what circumstances do they work?

Kirsh

Aron

Johnson

et al. 2017

BMC Health Serv Res

101

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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.

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Section: Methodsmentioning

confidence: 99%

A realist review of shared medical appointments: How, for whom, and under what circumstances do they work?

Kirsh

Aron

Johnson

et al. 2017

BMC Health Serv Res

101

View full text Add to dashboard Cite

show abstract

“…Originally designed in the 1970s for primary care pediatrics, the GVM has been applied successfully in the care of myriad chronic diseases in adults, including obesity, headache, diabetes, and coronary artery disease . Group visits have repeatedly been shown to improve medication adherence, reduce urgent care and emergency room visits, and facilitate health education and anticipatory guidance, while at the same time greatly improving health care resource utilization and clinic efficiency .…”

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confidence: 99%

Group visits in the pediatric heart transplant outpatient clinic

Hollander

McDonald

Lee

et al. 2015

Pediatric Transplantation

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The "GVM" has emerged as an alternative to traditional individualized appointments in the ambulatory care setting. We hypothesized that group visits could successfully be utilized in a PHtx clinic. Seven patients, ages 1-18 yr old, and their families participated in a total of 11 group visits in lieu of individualized appointments. Patients were divided into two groups based on whether they were greater or less than one yr post-transplant. Patient/provider satisfaction, medication adherence, and content retention were ascertained via questionnaires and free-response tests. Total clinic throughput time, including per-patient clinic utilization time, was compared to historical data. Six of seven patients completed the study with one dropout. Overall satisfaction ratings were 3.98 of 4 with all patients reporting that they would "strongly recommend" group visits to others. Health information retention tests demonstrated improvement between pre- and post-tests in eight of nine (89%) of the group visits. Overall clinic utilization decreased by nearly 50% while providing 70 min of face-to-face time with the provider. Medication adherence neared 100% for all patients. The GVM can be successfully applied to the PHtx population with high patient and provider satisfaction, more face-to-face time, excellent content retention, and greatly improved clinic efficiency.

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“…Real‐life experiences are strong advocates for behavioural changes and improved understanding of disease perspective and therapeutic interventions [30–32]. With regard to these aspects, a GMA could be superior to an IMA, especially in chronic patient care, which requires participants to deepen their knowledge of the disease and to improve adequate self management [17,24,33,34]. It has been suggested that GMAs may be especially effective in adolescents when they are offered according to their needs and requirements, as adolescents may be more sensitive to peers and group dynamics.…”

Section: Discussionmentioning

confidence: 99%

The group medical appointment (GMA) in haemophilia and von Willebrand’s disease: a new development in outpatient paediatric care

Lock¹,

Bruin²,

Scholten³

et al. 2012

Haemophilia

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The Group Medical Appointment (GMA) is a novel consultation form in which patients undergo individual consultations in each other's presence. To compare participants' experiences with GMA and Individual Medical Appointments (IMA), the usual standard of care, our team recently implemented the GMA for children aged 0-18 years with haemophilia or von Willebrand's disease. Participants' experiences with GMA were measured using a standardized QUOTE-questionnaire. Of 100 addressed families, 53 participated in GMA. Of these 53 families, 38 parents (72%) and 14 adolescents (82%) filled in the questionnaire about the GMA. Patients not on prophylaxis were defined as less experienced and patients on prophylaxis, as experienced. Although parents were satisfied with both GMA and IMA (median score 8.0 vs. 9.0 of 10), a significant difference was demonstrated between less experienced and experienced parents. After GMA, less experienced parents were significantly more satisfied (median score 8.0 vs. 5.0; P-value 0.006), felt more social support (82% vs. 30%; P-value 0.005) and reported additional learning effects with regard to disease and treatment (64% vs. 0%; P-value <0.001) than experienced parents. None of the less experienced parents reported privacy problems during GMA compared with 40% of experienced parents. In adolescents an identical trend was reported. Sixty-six per cent of parents would join a GMA in the future and 87% would recommend a GMA to others. The GMA is a valuable addition in haemophilia and von Willebrand care, especially for less experienced patients. It leads to improved satisfaction, social support and improved information.

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Group visits for rheumatoid arthritis patients: a pilot study

Cited by 15 publications

References 3 publications

A realist review of shared medical appointments: How, for whom, and under what circumstances do they work?

A realist review of shared medical appointments: How, for whom, and under what circumstances do they work?

Group visits in the pediatric heart transplant outpatient clinic

The group medical appointment (GMA) in haemophilia and von Willebrand’s disease: a new development in outpatient paediatric care

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