August 18, 2011

Shared Medical Appointments

This is one idea I do keep seeing more and more about. Now that I have discussed concierge medical practices in my last blog, I also feel this needs another look. The primary care physicians (PCPs) are under more and more pressure as their numbers decrease and few are entering the profession. When it comes to diabetes, there are also not enough endocrinologists specializing in diabetes to make it possible for everyone not having a good PCP to find an endocrinologist.

This is where shared medical appointments may become a necessity for many PCPs and endocrinologists specializing in diabetes. Studies have shown that they do work and work well. Often one of the benefits for patients is that they can see they are not alone and this builds bonds within the group participating in SMAs. It is the healing power of group interaction that has been well documented. Groups are inherently therapeutic and the interactions can often do wonders for the entire group.

I have mentioned this in my previous blogs on SMAs that this may not be for all doctors and even some patients, but it needs to be considered. Three general models for the shared medical appointment exist: 1) the cooperative health care clinic (CHCC), created for older patients requiring frequent, broad-spectrum care; 2) the disease-specific CHCC, a diagnostically exclusive group that aids patients with chronic-disease management; and 3) the drop-in group medical appointment (DIGMA), intended for established patients needing a more comprehensive approach to their follow-up care.

There are, however, an almost infinite number of variations of shared medical appointments that a care team may choose to incorporate into their practice, depending on the patient population they serve.

SMAs typically involve a medical provider, a facilitator (a nurse, behaviorist or health educator) a documenter (optional but cost-effective), an educator as needed, and one or two medical assistants (MAs) to check in patients. Administrative support is essential to ensure access, document and code patients’ visits, obtain confidentiality waivers, check in patients and prepare the room.

SMAs may be continuous, occurring at regular days and times and encouraging patients to form a cohesive group. A continuity group comprises the same people with the same physician and the same or similar conditions, or people who share a demographic characteristic, such as postmenopausal women. Membership changes occasionally through attrition or additions, but ongoing attendance is assumed.

Read these two articles about SMAs and the benefits, here, and here. For a rather lengthy description of one for diabetes, read the article in ADA Spectrum. There are many more sources and if you want to read more, use your search engine and enter “shared medical appointments”.

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