Shared medical appointments offer chronic care forums

While primarily thought of as an efficiency measure, there is mounting evidence that group visits also can improve the quality of patient care, particularly for those with chronic conditions such as diabetes and asthma, and, by doing so, lower healthcare costs.

A shared medical appointment is a physician-to-patient visit in the presence of other patients who benefit by hearing about the experiences of similar patients. During a typical 90-minute SMA, patients discuss their concerns in a forum and listen to strangers share their health concerns. Virtually everything-diagnoses, prescriptions, medical histories, treatment-is discussed in the group setting. An SMA is not a support group or psychiatry session, though it often does incorporate patient education. In addition to the physician and patients, SMAs usually are attended by one or more nurses or other clinical staff, who might act as facilitators.

Dr. Thacker says her first available individual appointment is typically eight months out, but she can see a patient within the week with an SMA.

"I can see a whole afternoon of patients in 90 minutes," she says. "If I can do four hours of work in two hours time, then I can do other things, like writing and research activities."

Dr. Thacker is likely on the leading edge of the trend.

In a survey by the American Academy of Family Physicians (AAFP), 8.4% of practices reported using SMAs in 2008, up from 5.7% percent in 2005. Among the institutions using group visits are: Kaiser Permanente Medical Centers at Santa Clara and San Jose, California; Borgess- Promed in Kalamazoo, Michigan; Sutter Medical Foundation in Sacramento, California; Parkland Health & Hospital System in Dallas; University of Virginia Health System; WellSpan Health in York, Pennsylvania, and the Cleveland Clinic.

A PricewaterhouseCoopers report on healthcare access in July 2009 cited SMAs as one way to ease the shortage of primary care physicians.