Group visits

Key points

1. Shared medical appointments (SMAs) are a series of consecutive individual medical consultations in a supportive group setting so everyone can listen, interact and learn.
2. SMAs can help remove patients' doubts about their ability to manage their illness. They can feel inspired by seeing others who are coping well.
3. Providers can also learn from patients about how better to meet their patients' needs.
4. A typical SMA lasts around 60–90 minutes, comprises 6–12 patients and includes a doctor and a facilitator – usually an allied health professional who manages group dynamics and directs the sessions.
5. There are four components needed so that SMAs become standard and routinely used: rigorous evidence, easy ways to pilot models, regulatory incentives to support SMAs and education.

What are shared medical appointments/group visits?

SMAs are a series of consecutive individual medical consultations in a supportive group setting where all can listen, interact, and learn. SMAs are also called group visits and are an evolving way of managing chronic disease in primary care. An SMA is both an individual consultation and an informal group education session. 

What are the benefits of shared medical appointments/group visits?

• Group exposure in SMAs combats isolation, which in turn helps to remove doubts about one’s ability to manage illness.
• Patients learn about disease self-management vicariously by witnessing others’ illness experiences.
• Patients feel inspired by seeing others who are coping well.
• Group dynamics lead patients and providers to developing more equitable relationships.
• Providers feel increased appreciation and rapport toward colleagues, leading to increased efficiency.
• Providers learn from the patients how better to meet their patients’ needs.
• Adequate time allotment of the SMA leads patients to feel supported.
• Patients receive professional expertise from the provider in combination with first-hand information from peers, resulting in more robust health knowledge.
• 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.

What are the different types of shared medical appointments/group visits?

There are two main types of SMAs: drop-in group medical appointments (DIGMAs) and programmed shared medical appointments (PSMAs).

DIGMAs can involve heterogenous groups with a range of standard medical problems. They are conducted at a standard time each week to reduce waiting time and enable acute care more accessible.

PSMAs are a sequence of SMAs in a semi-structured form providing educational input relating to a specific topic. A good example is a diabetes-focused group, which allows patients with diabetes to come together regularly to listen, interact and learn from each other and provides a good opportunity for a facilitator with extra training in diabetes to educate through a lecture or discussion format.

What’s a typical format for shared medical appointments/group visits?

SMAs could comprise 6–12 patients at a time and typically include a doctor and a facilitator, who is usually an allied health professional. The facilitator is the one who manages group dynamics and directs the 60–90 minute sessions. SMAs are suitable for you and your patients if you are frustrated with the limitations of 1:1 consulting.

Why are shared medical appointments/group visits not more common?

Why are doctors not routinely implementing SMAs to treat physical and mental conditions given the benefits of group interventions? There are four crucial components that are missing:

1. Rigorous scientific evidence supporting the value of shared appointments.
2. Easy ways to pilot and refine shared-appointment models before applying them in particular care settings.
3. Regulatory changes or incentives that support the use of such models.
4. Relevant patient and clinician education

These are necessary for any highly innovative service-delivery model including SMAs to become standard. 

References

1. Shared medical appointments Australasian Society of Lifestyle Medicine
2. A realist review of shared medical appointments: How, for whom, and under what circumstances do they work? BMC Health Services Research
3. Programmed shared medical appointments: A novel procedure for chronic disease management Australian Journal of General Practice