Shared medical appointments as a new model for carpal tunnel surgery consultation: A randomized clinical trial

Wong, Alison; Martin, Janet L.; Wong, Michael; Bezuhly, Michael; Tang, David

doi:10.1177/229255031602400210

Cited by 7 publications

(5 citation statements)

References 29 publications

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“…18,21,23 Four studies reported the education levels of their participants, with a majority of attendees having greater than high school education as their highest level of education (range 50.1% to 100%) (three studies) and one trial reported the majority of attendees having high school education or less as their highest level of education (100%). 16,21,23,25 Two studies reported their participants work demographics, with both reporting a minority of patients being employed (6.3% and 17%). 18,23…”

Section: Resultsmentioning

confidence: 99%

“…22 Of the four studies that measured patient satisfaction, there was no significant difference between SMA and usual care. 21,23,24,25…”

Section: Resultsmentioning

confidence: 99%

“…As a result of the small sample sizes, seven of the nine trials had low statistical power, thereby negatively impacting the probability of finding true effects. 20–25,35 Although it has been previously noted that this type of intervention is not possible to run as a double-blind trial, measures, such as patient satisfaction, are likely to have measurement bias. 36,37…”

Section: Strengths and Limitationsmentioning

confidence: 99%

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Shared medical appointments for patients with a nondiabetic physical chronic illness: A systematic review

et al. 2017

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Objectives Shared medical appointments are group appointments, with an optional individual consultation, for patients diagnosed with chronic illnesses. Shared medical appointments improve diabetes management, but little is known about their use for other illnesses. The objective was to determine the effect that shared medical appointments have on patients with a physical chronic illness, healthcare providers, and the healthcare system. Methods A systematic review was conducted searching databases from January 1970 to September 2016. Eligible trials evaluated shared medical appointments for patients with a homogeneous chronic illness, excluding diabetes and mental illness. Screening, data extraction, and risk of bias were conducted independently by two authors. Analysis was descriptive. Results Of 2364 citations, nine randomized trials were included. Shared medical appointments were evaluated for cardiovascular illnesses (four studies), breast cancer, chronic kidney disease, Parkinson's disease, stress urinary incontinence, and carpal tunnel syndrome. Compared to usual care, no negative effects on patient quality of life, knowledge and satisfaction were reported. One study reported no difference in healthcare provider satisfaction. Another study showed fewer hospital admissions for patients who attended shared medical appointments. Discussion Few rigorous studies evaluated the use of shared medical appointments for chronic illnesses. Overall, there appears to be no patient harms. Further studies should include more objective outcomes and larger sample sizes.

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Section: Resultsmentioning

confidence: 99%

“…22 Of the four studies that measured patient satisfaction, there was no significant difference between SMA and usual care. 21,23,24,25…”

Section: Resultsmentioning

confidence: 99%

Section: Strengths and Limitationsmentioning

confidence: 99%

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Shared medical appointments for patients with a nondiabetic physical chronic illness: A systematic review

et al. 2017

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“…Additional options to explore may include group medical appointments 31–34 or shared education classes 35 tailored to individuals considering MaPGAS, which would offer a moderated forum for discussing concerns, sharing experiences, and addressing questions in a supportive environment. Increased discussion of complications and the provision of photographs of surgical outcomes during consultations can further aid in setting realistic expectations and provide further decision support.…”

Section: Discussionmentioning

confidence: 99%

Exploring Decisional Conflict Experienced by Individuals Considering Metoidioplasty and Phalloplasty Gender-affirming Surgery

Otto-Moudry,

Kinney,

Butcher

et al. 2024

Plastic and Reconstructive Surgery - Global Open

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Background: Metoidioplasty and phalloplasty gender-affirming surgery (MaPGAS) is increasingly performed and requires patients to make complex decisions that may lead to decisional uncertainty. This study aimed to evaluate decisional conflict in individuals considering MaPGAS. Methods: We administered a cross-sectional survey to adult participants assigned female sex at birth and considering MaPGAS, recruited via social media platforms and community health centers. We collected data on demographics, medical and surgical history, MaPGAS type considered, and the Decisional Conflict Scale (DCS). DCS scores range from 0 to 100 (>37.5 indicates greater decisional conflict). Demographic characteristics and DCS scores were compared between subgroups, using descriptive and chi-square statistics. Participants commented on MaPGAS uncertainty, and their comments were evaluated and thematically analyzed. Results: Responses from 264 participants were analyzed: mean age 29 years; 64% (n = 168) trans men, 80% (n = 210) White, 78% (n = 206) nonrural, 45% (n = 120) privately insured, 56% (n = 148) had 4 or more years of college, 23% (n = 84) considering metoidioplasty, 24% (n = 87) considering phalloplasty, and 26% (n = 93) considering metoidioplasty and phalloplasty. DCS total scores were significantly higher (39.8; P < 0.001) among those considering both MaPGAS options, as were mean ratings on the Uncertainty subscale [64.1 (SD 25.5; P < 0.001)]. Concerns surrounding complications were the top factor contributing to uncertainty and decisional conflict. Conclusions: In a cross-sectional national sample of individuals seeking MaPGAS, decisional uncertainty was the highest for those considering both MaPGAS options compared with metoidioplasty or phalloplasty alone. This suggests this cohort would benefit from focused decision support.

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“…[1][2][3][4] Shared medical appointments are most commonly used in primary care settings, but they have been explored in other subspecialties, including some surgical practices. 5 This model has been studied in a limited number of chronic neurologic conditions, including neuromuscular disorders, 6 Parkinson disease, 7 and neuropathic pain. 8 These pilot studies yielded mixed results but suggested that these visits improve patient-reported outcomes and physician productivity.…”

Section: O N L I N E F I R S Tmentioning

confidence: 99%

Multiple Sclerosis Wellness Shared Medical Appointment Model

Abbatemarco

Cohen

Udeh

et al. 2021

International Journal of MS Care

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Background: Shared medical appointments (SMAs) are group medical visits combining medical care and patient education. We examined the impact of a wellness-focused pilot SMA in a large multiple sclerosis (MS) clinic. Methods: We reviewed data on all patients who participated in the SMA from January 2016 through June 2019. Data were collected 12 months pre/post SMA; included demographics, body mass index, patient-reported outcomes, and health care utilization; and were compared using Wilcoxon rank sum test. Results: Fifty adult patients (mean ± SD age, 50.1 ± 12.3 years) attended at least one MS wellness SMA. Most patients had private insurance (50%), and 26% had Medicaid coverage. The most common comorbidity was depression/anxiety (44%). Pre/post SMA outcomes showed a small but significant reduction in body mass index (30.2 ± 7.3 vs 28.8 ± 7.1, P = .03), and Patient Health Questionnaire-9 scores decreased from 7.3 ± 5.5 to 5.1 ± 5.6 (P = .001). The number of emergency department visits decreased from 13 to two (P = .0005), whereas follow-up visits increased with an attendees’ primary care provider from 19 to 41 (P < .001), physical therapist from 15 to 27 (P = .004), and psychologist from six to 19 (P = .003). Conclusions: This pilot MS wellness SMA was associated with improved physical and psychological outcomes. There was increased, lower-cost health care utilization with reduced acute, high-cost health care utilization, suggesting that SMAs may be a cost-effective and beneficial method in caring for patients with MS.

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Shared medical appointments as a new model for carpal tunnel surgery consultation: A randomized clinical trial

Abstract: These results support the use of shared appointments for large-volume, low-variation surgery.

Cited by 7 publications

References 29 publications

Shared medical appointments for patients with a nondiabetic physical chronic illness: A systematic review

Shared medical appointments for patients with a nondiabetic physical chronic illness: A systematic review

Exploring Decisional Conflict Experienced by Individuals Considering Metoidioplasty and Phalloplasty Gender-affirming Surgery

Multiple Sclerosis Wellness Shared Medical Appointment Model

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