Question

Give background information from peer-reviewed literature and the rationale to support the implementation of shared medical appointments (SMA) in a primary care clinic that offers group education for Adults with hypertension to increase compliance of managing their blood pressure

Answer 1

Shared medical appointments (SMAs) are becoming popular, but little is known about their association with patient experience in primary care. We performed an exploratory analysis examining overall satisfaction and patient-centered care experiences across key domains of the patient-centered medical home among patients attending SMAs vs usual care appointments.

Shared medical appointments (SMAs) are doctor-patient visits in which groups of patients are seen by one or more health care providers in a concurrent session. There is a growing interest in understanding the potential benefits of SMAs in various contexts to improve clinical outcomes and reduce healthcare costs.

Shared medical appointments (SMAs), or group visits, have demonstrated enhanced access and productivity in primary care. The Patient Protection and Affordable Care Act of 2010 has coincided with the emergence of patient-centered medical homes (PCMHs) that are embracing innovative methods of care delivery to increase the role of primary care. Organizations transforming their care delivery approach toward a medical home model seek strategies to accommodate increased numbers of patients projected to become insured under the Act. SMAs represent a potential innovation to improve access, cost, disease management outcomes, and patient-centered care.

Patient-centered care and satisfaction are increasingly being recognized as essential components of health care quality, and large payers are recognizing patient-centered care as a core element of quality health care delivery and have started to link measures of patient satisfaction to reimbursement. As one of the pioneer Accountable Care Organizations, Harvard Vanguard Medical Associates, a large, multispecialty group practice in eastern Massachusetts, has implemented novel programs focused on disease management and patient experience.

A shared medical appointment (SMA) is a clinical encounter in which a group of patients receive patient education and counseling, physical examination, and clinical support in a group setting. Typically SMAs are designed to have one or more health care provider(s) attend to a group of patients who share a common illness or demographic make-up. In contrast to group education alone, patients in SMAs engage in care that may include a physical exam, medication adjustments or other clinical interventions that are tailored to the needs of the group as well as the individual patients. In contrast to one-on-one visits, SMAs provide a longer appointment timeframe as well as the opportunity for patients to witness patient-provider interactions and share in peer support.

Interest in SMA interventions has been increasing due to the potential for enhancing the quality of healthcare, mitigating health disparities, improving self-management, and cost-saving. Previous systematic reviews of SMAs have mainly focused on the question of efficacy. Although both primary studies and systematic reviews have demonstrated efficacy “on the average”, results from individual studies are quite varied. In addition, a search through the literature has revealed many studies involving SMAs (now >100) that demonstrate significant diversity in terms of implementation context, intervention approach, and assessment methodology. Although a variety of explanations have been offered about how SMAs work, there has been relatively little robust middle-range programme theory development that would allow better targeting of SMA interventions to patients and contexts where it is most likely to be effective.