Shared Medical Appointments for Patients with Kidney Stones New to Medical Management Decrease Appointment Wait Time and Increase Patient Knowledge

Jhagroo, R. Allan; Nakada, Stephen Y.; Penniston, Kristina L.

doi:10.1016/j.juro.2013.05.037

Cited by 26 publications

(22 citation statements)

References 17 publications

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“…After cause and effect analysis, we implemented shared medical appointments (SMAs) as a corrective action. 16 As previously reported, we reduced the wait time to appointment-shortening the time from stone event to the establishment of preventive care-and maintained high patient satisfaction. With this innovative model we have also ensured that all new patients receive nutritional care that includes a comprehensive review of dietary associations with kidney stones as well as individualized therapeutic regimens.…”

Section: Introductionsupporting

confidence: 77%

“…Both patient satisfaction and knowledge of disease are as good as or better than among patients who attend individual appointments for their initial stone clinic visit. 16 As a next step in evaluating the efficacy of SMAs for establishing preventive stone care, we assessed whether patients attending SMAs achieved the same improvements in their stone risk factors as patients attending traditional individual appointments. To do this, we evaluated 24-hour urine risk factors before and after initial appointment and compared results between patients who attended SMAs and those from individual patient appointments (IPAs).…”

Section: Introductionmentioning

confidence: 99%

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Patients Attending Shared Medical Appointments for Metabolic Stone Prevention Have Decreased Stone Risk Factors

Jhagroo

Nakada

Penniston

2016

Journal of Endourology

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Section: Introductionsupporting

confidence: 77%

Section: Introductionmentioning

confidence: 99%

Patients Attending Shared Medical Appointments for Metabolic Stone Prevention Have Decreased Stone Risk Factors

Jhagroo

Nakada

Penniston

2016

Journal of Endourology

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“…In addition, the review identified four surveys 96,[108][109][110] to be used to corroborate findings from qualitative evidence. Three of the surveys were conducted in the USA, [108][109][110] with the remaining survey from the Netherlands 96 (Table 20).…”

Section: Characteristics Of Surveysmentioning

confidence: 99%

“…Three of the surveys were conducted in the USA, [108][109][110] with the remaining survey from the Netherlands 96 (Table 20). Two surveys explored GMAs 96,110 and one survey examined DIGMAs.…”

Section: Characteristics Of Surveysmentioning

confidence: 99%

“…Two surveys explored GMAs 96,110 and one survey examined DIGMAs. 108 Jhagroo et al 109 reported an adaptation of three models: the DIGMA, the CHCC and the physical SMA. As quality assessment of surveys is problematic, these papers were not critically appraised, and data were used only to triangulate findings and not to generate themes.…”

Section: Characteristics Of Surveysmentioning

confidence: 99%

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What is the evidence for the effectiveness, appropriateness and feasibility of group clinics for patients with chronic conditions? A systematic review

Cantrell

Preston

Chambers

et al. 2015

Health Serv Deliv Res

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BackgroundGroup clinics are a form of delivering specialist-led care in groups rather than in individual consultations.ObjectiveTo examine the evidence for the use of group clinics for patients with chronic health conditions.DesignA systematic review of evidence from randomised controlled trials (RCTs) supplemented by qualitative studies, cost studies and UK initiatives.Data sourcesWe searched MEDLINE, EMBASE, The Cochrane Library, Web of Science and Cumulative Index to Nursing and Allied Health Literature from 1999 to 2014. Systematic reviews and RCTs were eligible for inclusion. Additional searches were performed to identify qualitative studies, studies reporting costs and evidence specific to UK settings.Review methodsData were extracted for all included systematic reviews, RCTs and qualitative studies using a standardised form. Quality assessment was performed for systematic reviews, RCTs and qualitative studies. UK studies were included regardless of the quality or level of reporting. Tabulation of the extracted data informed a narrative synthesis. We did not attempt to synthesise quantitative data through formal meta-analysis. However, given the predominance of studies of group clinics for diabetes, using common biomedical outcomes, this subset was subject to quantitative analysis.ResultsThirteen systematic reviews and 22 RCT studies met the inclusion criteria. These were supplemented by 12 qualitative papers (10 studies), four surveys and eight papers examining costs. Thirteen papers reported on 12 UK initiatives. With 82 papers covering 69 different studies, this constituted the most comprehensive coverage of the evidence base to date. Disease-specific outcomes – the large majority of RCTs examined group clinic approaches to diabetes. Other conditions included hypertension/heart failure and neuromuscular conditions. The most commonly measured outcomes for diabetes were glycated haemoglobin A1c(HbA1c), blood pressure and cholesterol. Group clinic approaches improved HbA1cand improved systolic blood pressure but did not improve low-density lipoprotein cholesterol. A significant effect was found for disease-specific quality of life in a few studies. No other outcome measure showed a consistent effect in favour of group clinics. Recent RCTs largely confirm previous findings. Health services outcomes – the evidence on costs and feasibility was equivocal. No rigorous evaluation of group clinics has been conducted in a UK setting. A good-quality qualitative study from the UK highlighted factors such as the physical space and a flexible appointment system as being important to patients. The views and attitudes of those who dislike group clinic provision are poorly represented. Little attention has been directed at the needs of people from ethnic minorities. The review team identified significant weaknesses in the included research. Potential selection bias limits the generalisability of the results. Many patients who could potentially be included do not consent to the group approach. Attendance is often interpreted liberally.LimitationsThis telescoped review, conducted within half the time period of a conventional systematic review, sought breadth in covering feasibility, appropriateness and meaningfulness in addition to effectiveness and cost-effectiveness and utilised several rapid-review methods. It focused on the contribution of recently published evidence from RCTs to the existing evidence base. It did not reanalyse trials covered in previous reviews. Following rapid review methods, we did not perform independent double data extraction and quality assessment.ConclusionsAlthough there is consistent and promising evidence for an effect of group clinics for some biomedical measures, this effect does not extend across all outcomes. Much of the evidence was derived from the USA. It is important to engage with UK stakeholders to identify NHS considerations relating to the implementation of group clinic approaches.Future workThe review team identified three research priorities: (1) more UK-centred evaluations using rigorous research designs and economic models with robust components; (2) clearer delineation of individual components within different models of group clinic delivery; and (3) clarification of the circumstances under which group clinics present an appropriate alternative to an individual consultation.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Strategies for Counseling Patients in Clinic

Jhagroo

2017

Nutrition Therapy for Urolithiasis

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Shared Medical Appointments for Patients with Kidney Stones New to Medical Management Decrease Appointment Wait Time and Increase Patient Knowledge

Abstract: Shared medical appointments can be an efficient way to evaluate and manage new patients for urolithiasis prevention. Patient satisfaction was high and knowledge about prevention was higher than that of patients seen in individual appointments.

Cited by 26 publications

References 17 publications

Patients Attending Shared Medical Appointments for Metabolic Stone Prevention Have Decreased Stone Risk Factors

Patients Attending Shared Medical Appointments for Metabolic Stone Prevention Have Decreased Stone Risk Factors

What is the evidence for the effectiveness, appropriateness and feasibility of group clinics for patients with chronic conditions? A systematic review

Strategies for Counseling Patients in Clinic

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