Shared Medical Appointments to Screen for Geriatric Syndromes: Preliminary Data from a Quality Improvement Initiative

Abstract

Older adults are at greater risk of developing conditions that affect health outcomes, quality of life, and costs of care. Screening for geriatric conditions such as memory loss, fall risk, and depression may contribute to the prevention of adverse physical and mental comorbidities, unnecessary hospitalizations, and premature nursing home admissions. Because screening is not consistently performed in primary care settings, a shared medical appointment (SMA) program was developed to fill this gap in care. The goals of the program were to improve early identification of at-risk individuals and ensure appropriate follow-up for memory loss, fall risk, and depression; facilitate discussion about prevention, diagnosis, and treatment of these conditions; implement strategies to reduce risks for these conditions; and increase access to screening and expand preventive health services for older adults. Between August 2011 and May 2013, 136 individuals aged 60 and older participated in the program. Three case studies highlighting the psychosocial and physiological findings of participation in the program are presented. Preliminary data suggest that SMAs are an effective model of regularly screening at-risk older adults that augments primary care practice by facilitating early detection and referral for syndromes that may otherwise be missed or delayed.

Advance Care Planning Meets Group Medical Visits: The Feasibility of Promoting Conversations

“…Percentage of patients ested and will participate in GMV on advance care planning. 13,34,35 On the other hand, the actual group sizes were lower than our goal and were limited by the rate of referrals, the number of patients who were unable to participate, and last minute cancelations and rescheduling. Patients in groups of 4 or 5 seemed less engaged in the discussion than those in groups of 7 or 9 patients, suggesting that group size may have an important effect on outcomes.…”

“…11,12 GMVs, also called shared medical appointments, engage patients in health promotion and disease management. [13][14][15][16][17][18] care, and self-efficacy, as well as decreased health care utilization.…”

“…11,12 GMVs, also called shared medical appointments, engage patients in health promotion and disease management. [13][14][15][16][17][18] care, and self-efficacy, as well as decreased health care utilization.19 Key GMV strengths include increased patient satisfaction, support for behavior change, and patient engagement. 16,18 Given how GMVs support patient engagement through group interaction, we developed the first advance care planning group visit, the "Conversation Group Medical Visit."…”

“…11,12 GMVs, also called shared medical appointments, engage patients in health promotion and disease management. [13][14][15][16][17][18] Older adults enrolled in chronic disease management GMVs showed improved health status, satisfaction with care, and self-efficacy, as well as decreased health care utilization. 19 Key GMV strengths include increased patient satisfaction, support for behavior change, and patient engagement.…”

Shared medical appointments

“…The strongest clinical evidence is in diabetes, where shared appointments result in demonstrable improvements in HbA1c and blood pressure. 4 Studies have, however, successfully used SMAs in many other conditions and settings, in primary and secondary care, including care for cancer survivors, 5 high use of medical care, 4 pain management, 6 substance misuse, 7 health screening for elderly people, 8 and chronic heart disease. 3 Technology, including video conferencing, has also been used to provide SMAs for patients living in rural areas or those with mobility difficulties.…”