Group Medical Care: A Systematic Review of Health Service Performance

Abstract

Group care models, in which patients with similar health conditions receive medical services in a shared appointment, have increasingly been adopted in a variety of health care settings. Applying the Triple Aim framework, we examined the potential of group medical care to optimize health system performance through improved patient experience, better health outcomes, and the reduced cost of health care. A systematic review of English language articles was conducted using the Cochrane Controlled Trials Register (CENTRAL), MEDLINE/PubMed, Scopus, and Embase. Studies based on data from randomized control trials (RCTs) conducted in the US and analyzed using an intent-to-treat approach to test the effect of group visits versus standard individual care on at least one Triple Aim domain were included. Thirty-one studies met the inclusion criteria. These studies focused on pregnancy (n = 9), diabetes (n = 15), and other chronic health conditions (n = 7). Compared with individual care, group visits have the potential to improve patient experience, health outcomes, and costs for a diversity of health conditions. Although findings varied between studies, no adverse effects were associated with group health care delivery in these randomized controlled trials. Group care models may contribute to quality improvements, better health outcomes, and lower costs for select health conditions.

Determinants of implementation for group medical visits for patients with chronic pain: a systematic review

“…A systematic review of patient-centered experience in GMVs/shared medical appointments for a wide range of conditions found many benefits to GMVs over individual care, including extended time, higher levels of patient satisfaction overall and with patient-clinician relationships, benefits of peer support, and high levels of engagement among patient participants [ 73 ]. Recently, a systematic review evaluating the potential of GMVs to address the Triple Aim of healthcare improvement found evidence of benefits of GMVs in all three aims [ 29 ].…”

Feasibility and efficacy of implementing group visits for women’s health conditions: a systematic review

“…Current evidence indicates group visits may have a positive impact on health service delivery. In studies to date, group visits have been shown to (a) be more cost-effective than one-on-one consultations [5,6], (b) increase accessibility to healthcare in diverse and/or underserved populations [7], (c) be well-received by patients and providers [5,8], and (d) be effective in managing conditions such as diabetes [9,10] and chronic pain [11,12]. The group dynamic can provide additional benefits to patients where a sense of human connection and empowerment may be fostered alongside increased capacity for patient education [3,13].…”

“…The group dynamic can provide additional benefits to patients where a sense of human connection and empowerment may be fostered alongside increased capacity for patient education [3,13]. To date, no adverse effects have been associated with group-delivered health care [6]. Although several studies suggest patients attending group visits may receive more comprehensive care (than those attending one-on-one care), there may be disadvantages to the model.…”

“…Although several studies suggest patients attending group visits may receive more comprehensive care (than those attending one-on-one care), there may be disadvantages to the model. For example, some studies have favoured one-on-one care for the amount and quality of time spent with the practitioner (audiologist) [6]. Disadvantages reported by Australian providers have mainly been attributed to initial administrative issues which have been overcome at subsequent group visits [8].…”

Group medicare wellness visits: A pilot exploration of an approach to wellness and preventive medicine for older adults

“…To increase access to MWV among our older adult primarily Black patients in Detroit, thereby increasing our ability to address health maintenance gaps (HMG), our team adapted these visits to a shared medical appointment group visit format ( Noffsinger, 1999 ). Group visits have been shown to lead to positive health outcomes through improved patient experience ( Cunningham et al, 2021 ), specifically in patients with chronic pain ( Lestoquoy et al, 2017 ), attempting weight loss ( Axten et al, 2017 ) as well as for patients who are older ( Cherniack, 2014 ) and needing advanced care planning ( Lum et al, 2016 , Lum et al, 2017 ). Group visits effectiveness could be due to increased patient satisfaction ( Egger et al, 2015 , Heyworth et al, 2014 ) and easing primary care provider burden ( Egger et al, 2015 , Stults et al, 2016 ).…”