Shared medical appointments and patient-centered experience: a mixed-methods systematic review

Abstract

Background Shared medical appointments (SMAs), or group visits, are a healthcare delivery method with the potential to improve chronic disease management and preventive care. In this review, we sought to better understand opportunities, barriers, and limitations to SMAs based on patient experience in the primary care context. Methods An experienced biomedical librarian conducted literature searches of PubMed, Cochrane Library, PsycINFO, CINAHL, Web of Science, ClinicalTrials.gov , and SSRN for peer-reviewed publications published 1997 or after. We searched grey literature, nonempirical reports, social science publications, and citations from published systematic reviews. The search yielded 1359 papers, including qualitative, quantitative, and mixed method studies. Categorization of the extracted data informed a thematic synthesis. We did not perform a formal meta-analysis. Results Screening and quality assessment yielded 13 quantitative controlled trials, 11 qualitative papers, and two mixed methods studies that met inclusion criteria. We identified three consistent models of care: cooperative health care clinic (five articles), shared medical appointment / group visit (10 articles) and group prenatal care / CenteringPregnancy® (11 articles). Conclusions SMAs in a variety of formats are increasingly employed in primary care settings, with no singular gold standard. Accepting and implementing this nontraditional approach by both patients and clinicians can yield measurable improvements in patient trust, patient perception of quality of care and quality of life, and relevant biophysical measurements of clinical parameters. Further refinement of this healthcare delivery model will be best driven by standardizing measures of patient satisfaction and clinical outcomes. Electronic supplementary material The online version of this article (10.1186/s12875-019-0972-1) contains supplementary material, which is available to authorized users.

Experience of implementing and delivering group consultations in UK general practice: a qualitative study

“…The themes identified from professionals are consistent with the literature regarding patients who have participated in group consultations, which has shown positive data relating to the patient–clinician dynamic, improved satisfaction, and a perception that staff appear less hurried. 12 …”

“…Evidence from systematic reviews and meta-analyses suggests that group consultations are effective in improving clinical outcomes, such as haemoglobin A1C (HbA1c) and blood pressure in diabetes, and are associated with positive patient experience measures, although questions remain about the impact on other clinical outcomes and the feasibility and cost-effectiveness of the approach. 10 , 11 Although few studies have cited barriers to implementation, 12 a lack of confidence and skills in facilitation, along with an ingrained, established model of consultation, are suggested reasons for hesitancy regarding the approach. 9 , 13 , 14 However, a paucity of evidence exploring implementation in UK general practice exists.…”

Association between shared medical appointments and weight loss outcomes and anti‐obesity medication use in patients with obesity

“…Data on the use of SMAs continue to accumulate, particularly in the field of diabetes . Reviews of such research have concluded that while there are indications of improved outcomes in patients managed with SMAs, the small size and heterogeneity of studies thus far does not allow for conclusions to be drawn from the collective body of research …”

Lifestyle Medicine Shared Medical Appointments

“…17 SMAs are usually conducted over a 2-hour period. 22 It is important to note that each SMA requires private time for each patient with the provider. During this time, the patient will have the opportunity to discuss issues they may not feel comfortable discussing in the group format.…”