Veteran Experiences Related to Participation in Shared Medical Appointments

Cohen, Shannon Munro; Hartley, Sarah; Mavi, Jasbir; Vest, Bridgette; Wilson, Monica

doi:10.7205/milmed-d-12-00212

Cited by 20 publications

(21 citation statements)

References 26 publications

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“…Eight richer studies were particularly influential in populating the conceptual framework and subsequent synthesis. [96][97][98][99][101][102][103]111 Findings 1: feeling supported A common finding was that the group environment offered individuals an opportunity to derive support from others in a similar or comparable position to them. Such support could be accessed during the initial socialisation sessions or, subsequently, when engaging in group education or interaction with clinicians.…”

Section: Quality Of Included Qualitative Studiesmentioning

confidence: 99%

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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Section: Quality Of Included Qualitative Studiesmentioning

confidence: 99%

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

View full text Add to dashboard Cite

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Section: Introductionmentioning

confidence: 99%

“…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." This model leverages group dynamic to transform the typical patient-clinician encounter related to advance care planning.…”

mentioning

confidence: 99%

“…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."…”

mentioning

confidence: 99%

“…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.…”

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confidence: 99%

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

et al. 2016

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PURPOSE Primary care needs new models to facilitate advance care planning conversations. These conversations focus on preferences regarding serious illness and may involve patients, decision makers, and health care providers. We describe the feasibility of the first primary care-based group visit model focused on advance care planning. METHODSWe conducted a pilot demonstration of an advance care planning group visit in a geriatrics clinic. Patients were aged at least 65 years. Groups of patients met in 2 sessions of 2 hours each facilitated by a geriatrician and a social worker. Activities included considering personal values, discussing advance care planning, choosing surrogate decision-makers, and completing advance directives. We used the RE-AIM framework to evaluate the project. RESULTSTen of 11 clinicians referred patients for participation. Of 80 patients approached, 32 participated in 5 group visit cohorts (a 40% participation rate) and 27 participated in both sessions (an 84% retention rate). Mean age was 79 years; 59% of participants were female and 72% white. Most evaluated the group visit as better than usual clinic visits for discussing advance care planning. Patients reported increases in detailed advance care planning conversations after participating (19% to 41%, P = .02). Qualitative analysis found that older adults were willing to share personal values and challenges related to advance care planning and that they initiated discussions about a broad range of relevant topics.CONCLUSION A group visit to facilitate discussions about advance care planning and increase patient engagement is feasible. This model warrants further evaluation for effectiveness in improving advance care planning outcomes for patients, clinicians, and the system. 2016;14:125-132. doi: 10.1370/afm.1906. Ann Fam Med INTRODUCTIOND espite the benefits of advance care planning for patients, primary care clinicians face barriers to effective counseling on the issue, including their limited time and a lack of clinic-based support. [1][2][3][4] The Dying in America report 5 emphasized the need to integrate advance care planning into clinical care, and the Centers for Medicare and Medicaid Services recently approved reimbursement for counseling on advance care planning. 6 Advance care planning is an ongoing process that involves multiple conversations among individuals, family members, and health care professionals. 1,7 Studies show that many US decedents had not discussed preferences for end-of-life care with someone close to them, completed a living will, or established a durable power of attorney for health care. 8,9 Primary care clinics are uniquely positioned to implement new models that engage patients in advance care planning. 10 The American Academy of Family Physicians recognizes group medical visits (GMVs) as a strategic approach within the patient-centered medical home. 11,12 GMVs, also called shared medical appointments, engage patients in health promotion and disease management. [13][14][15][16][17][18] care, a...

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Shared medical appointments for patients with diabetes: Glycemic reduction in high-risk patients

Watts

Strauss

Pascuzzi

et al. 2015

Journal of the American Association of Nurse Practitioners

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Purpose To assess the impact on glycemic control (A1c, %) in a primary care urban Veterans Affairs (VA) shared medical appointments (SMAs). Data sources A retrospective pretest/posttest study included all patients who had attended ≥1 SMA from 4/06 to 12/10. A1cs 810 days pre‐ and postinitial SMA were obtained from 90‐day time periods. A1c levels were averaged within patient in these 90‐day intervals and data were aggregated based upon corresponding time intervals. Conclusions Of 1290 individuals seen in SMAs, 1288 (99.8%) had ≥1 A1c levels and 1170 (90.7%) individuals had ≥1 level collected both before and after attendance. The sample was predominantly (96%) male and middle aged or older (mean [±1 SD] age of 62.6 + 9.09 years) with a mean Diabetes Severity Index 3.01 (2.34). There were significant A1c reductions (∼1%) in A1c overall (n = 1170) and for patients with ≥1 measurement in the 180‐day periods preceding and following their first SMA appointment (n = 815). Linear regression analysis showed a significant (p < .001) pre‐SMA positive trend (r2 = 0.90). Implications for practice Limitations notwithstanding (single site and design lacking a control group), the large number of patients demonstrates SMA clinical effectiveness in improving A1c for high‐risk patients with diabetes.

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Veteran Experiences Related to Participation in Shared Medical Appointments

Cited by 20 publications

References 26 publications

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

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

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

Shared medical appointments for patients with diabetes: Glycemic reduction in high-risk patients

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