Shared Medical Appointments: Challenges and Opportunities

Sikon, Andrea; Bronson, David L.

doi:10.7326/0003-4819-152-11-201006010-00012

Cited by 21 publications

(24 citation statements)

References 6 publications

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“…15,37 Potential financial challenges include adequate reimbursement for services, including patient co-payments, though multiple health care systems are successfully implementing and sustaining GMVs. 15,25,36 The Conversation GMV can be facilitated by providers other than physicians, such as nurse practitioners or physician assistants, 38 as long as they are trained in GMV facilitation and counseling in advance care planning. The Centers for Medicare and Medicaid Services recently approved payment for CPT codes for counseling in advance care planning, supporting the integration of advance care planning into clinical settings.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…11,12 GMVs, also called shared medical appointments, engage patients in health promotion and disease management. [13][14][15][16][17][18] care, and self-efficacy, as well as decreased health care utilization.19 Key GMV strengths include increased patient satisfaction, support for behavior change, and patient engagement. 16,18 Given how GMVs support patient engagement through group interaction, we developed the first advance care planning group visit, the "Conversation Group Medical Visit."…”

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confidence: 99%

“…11,12 GMVs, also called shared medical appointments, engage patients in health promotion and disease management. [13][14][15][16][17][18] Older adults enrolled in chronic disease management GMVs showed improved health status, satisfaction with care, and self-efficacy, as well as decreased health care utilization. 19 Key GMV strengths include increased patient satisfaction, support for behavior change, and patient engagement.…”

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Advance Care Planning Meets Group Medical Visits: The Feasibility of Promoting Conversations

et al. 2016

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PURPOSE Primary care needs new models to facilitate advance care planning conversations. These conversations focus on preferences regarding serious illness and may involve patients, decision makers, and health care providers. We describe the feasibility of the first primary care-based group visit model focused on advance care planning. METHODSWe conducted a pilot demonstration of an advance care planning group visit in a geriatrics clinic. Patients were aged at least 65 years. Groups of patients met in 2 sessions of 2 hours each facilitated by a geriatrician and a social worker. Activities included considering personal values, discussing advance care planning, choosing surrogate decision-makers, and completing advance directives. We used the RE-AIM framework to evaluate the project. RESULTSTen of 11 clinicians referred patients for participation. Of 80 patients approached, 32 participated in 5 group visit cohorts (a 40% participation rate) and 27 participated in both sessions (an 84% retention rate). Mean age was 79 years; 59% of participants were female and 72% white. Most evaluated the group visit as better than usual clinic visits for discussing advance care planning. Patients reported increases in detailed advance care planning conversations after participating (19% to 41%, P = .02). Qualitative analysis found that older adults were willing to share personal values and challenges related to advance care planning and that they initiated discussions about a broad range of relevant topics.CONCLUSION A group visit to facilitate discussions about advance care planning and increase patient engagement is feasible. This model warrants further evaluation for effectiveness in improving advance care planning outcomes for patients, clinicians, and the system. 2016;14:125-132. doi: 10.1370/afm.1906. Ann Fam Med INTRODUCTIOND espite the benefits of advance care planning for patients, primary care clinicians face barriers to effective counseling on the issue, including their limited time and a lack of clinic-based support. [1][2][3][4] The Dying in America report 5 emphasized the need to integrate advance care planning into clinical care, and the Centers for Medicare and Medicaid Services recently approved reimbursement for counseling on advance care planning. 6 Advance care planning is an ongoing process that involves multiple conversations among individuals, family members, and health care professionals. 1,7 Studies show that many US decedents had not discussed preferences for end-of-life care with someone close to them, completed a living will, or established a durable power of attorney for health care. 8,9 Primary care clinics are uniquely positioned to implement new models that engage patients in advance care planning. 10 The American Academy of Family Physicians recognizes group medical visits (GMVs) as a strategic approach within the patient-centered medical home. 11,12 GMVs, also called shared medical appointments, engage patients in health promotion and disease management. [13][14][15][16][17][18] care, a...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Advance Care Planning Meets Group Medical Visits: The Feasibility of Promoting Conversations

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“…These patients would be fast-tracked through the program while more resources are directed toward patients requiring intensive evaluation. Other interventions can also be implemented to improve performance, such as group counselling 26,27 and enhanced triaging of patients. For instance, if relevant medical and psychosocial information is collected at referral, 25 patients can be directed to assessments that best address any potential clinical issues early in their sequence of care.…”

Section: Discussionmentioning

confidence: 99%

Patient and operational factors affecting wait times in a bariatric surgery program in Toronto: a retrospective cohort study

et al. 2015

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Background:Increasing rates of obesity have led to growing demand for bariatric surgery. This has implications for wait times, particularly in publicly funded programs. This study examined the impact of patient and operational factors on wait times in a multidisciplinary bariatric surgery program. Methods:A retrospective study was conducted involving patients who were referred to a tertiary care centre (University Health Network, Toronto Western Hospital, Toronto) for bariatric surgery between June 2008 and July 2011. Patient characteristics, dates of clinical assessments and records describing operational changes were collected. Univariable analysis and multivariable log-linear and parametric time-to-event regressions were performed to determine whether patient and operational covariates were associated with the wait time for bariatric surgery (i.e., length of preoperative evaluation). Results:Of the 1664 patients included in the analysis, 724 underwent surgery with a mean wait time of 440 (standard deviation 198) days and a median wait time of 445 (interquartile range 298−533) days. Wait times ranged from 3 months to 4 years. Univariable and multivariable analyses showed that patients with active substance use (β = 0.3482, p = 0.02) and individuals who entered the program in more recent operational periods (β = 0.2028, p < 0.001) had longer wait times. Additionally, the median time-to-surgery increased over 3 discrete operational periods (characterized by specific program changes related to scheduling and staffing levels, and varying referral rates and defined surgical targets; p < 0.001).Interpretation: Some patients could be identified at referral as being at risk for longer wait times. We also found that previous operational decisions significantly increased the wait time in the program since its inception. Therefore, careful consideration must be devoted to process-level decision-making for multistage bariatric surgical programs, because managerial and procedural changes can affect timely access to treatment. Abstract Research CMAJ OPEN E332CMAJ OPEN, 3(3)

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Comparative Effectiveness of Goal Setting in Diabetes Mellitus Group Clinics

Naik¹,

Palmer²,

Petersen³

et al. 2011

Arch Intern Med

162

228

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Background Diabetes group clinics can effectively control hypertension, but data to support glycemic control is equivocal. This study evaluated the comparative effectiveness of two diabetes group clinic interventions on glycosolated hemoglobin (HbA1c) levels in primary care. Methods Participants (n = 87) were recruited from a diabetes registry of a single regional VA medical center to participate in an open, randomized comparative effectiveness study. Two primary care based diabetes group interventions of three months duration were compared. Empowering Patients in Care (EPIC) was a clinician-led, patient-centered group clinic consisting of four sessions on setting self-management action plans (diet, exercise, home monitoring, medications, etc.) and communicating about progress with action plans. The comparison intervention consisted of group education sessions with a diabetes educator and dietician followed by an additional visit with one’s primary care provider. HbA1c levels were compared post-intervention and at one-year follow-up. Results Participants in the EPIC intervention had significantly greater improvements in HbA1c levels immediately following the active intervention (8.86 to 8.04 vs. 8.74 to 8.70, mean [SD] between-group difference 0.67±1.3, P=.03) and these differences persisted at 1 year follow-up (.59±1.4, P=.05). A repeated measures analysis using all study time points found a significant time-by-treatment interaction effect on HbA1c levels favoring the EPIC intervention (F(2,85) =3.55, P= .03). The effect of the time-by-treatment interaction appears to be partially mediated by diabetes self-efficacy (F(1,85) =10.39, P= .002). Conclusions Primary care based diabetes group clinics that include structured goal-setting approaches to self-management can significantly improve HbA1c levels post-intervention and maintain improvements for 1-year. Trial registration ClinicalTrials.gov Identifier: NCT00481286

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Shared Medical Appointments: Challenges and Opportunities

Cited by 21 publications

References 6 publications

Advance Care Planning Meets Group Medical Visits: The Feasibility of Promoting Conversations

Advance Care Planning Meets Group Medical Visits: The Feasibility of Promoting Conversations

Patient and operational factors affecting wait times in a bariatric surgery program in Toronto: a retrospective cohort study

Comparative Effectiveness of Goal Setting in Diabetes Mellitus Group Clinics

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