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Otto-Moudry R, Kinney LM, Butcher RL, Blasdel G, Brown LK, Elwyn G, Myers JB, Turco JH, Nigriny JF, Moses RA. Exploring Decisional Conflict Experienced by Individuals Considering Metoidioplasty and Phalloplasty Gender-affirming Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5840. [PMID: 38818233 PMCID: PMC11139465 DOI: 10.1097/gox.0000000000005840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 03/27/2024] [Indexed: 06/01/2024]
Abstract
Background Metoidioplasty and phalloplasty gender-affirming surgery (MaPGAS) is increasingly performed and requires patients to make complex decisions that may lead to decisional uncertainty. This study aimed to evaluate decisional conflict in individuals considering MaPGAS. Methods We administered a cross-sectional survey to adult participants assigned female sex at birth and considering MaPGAS, recruited via social media platforms and community health centers. We collected data on demographics, medical and surgical history, MaPGAS type considered, and the Decisional Conflict Scale (DCS). DCS scores range from 0 to 100 (>37.5 indicates greater decisional conflict). Demographic characteristics and DCS scores were compared between subgroups, using descriptive and chi-square statistics. Participants commented on MaPGAS uncertainty, and their comments were evaluated and thematically analyzed. Results Responses from 264 participants were analyzed: mean age 29 years; 64% (n = 168) trans men, 80% (n = 210) White, 78% (n = 206) nonrural, 45% (n = 120) privately insured, 56% (n = 148) had 4 or more years of college, 23% (n = 84) considering metoidioplasty, 24% (n = 87) considering phalloplasty, and 26% (n = 93) considering metoidioplasty and phalloplasty. DCS total scores were significantly higher (39.8; P < 0.001) among those considering both MaPGAS options, as were mean ratings on the Uncertainty subscale [64.1 (SD 25.5; P < 0.001)]. Concerns surrounding complications were the top factor contributing to uncertainty and decisional conflict. Conclusions In a cross-sectional national sample of individuals seeking MaPGAS, decisional uncertainty was the highest for those considering both MaPGAS options compared with metoidioplasty or phalloplasty alone. This suggests this cohort would benefit from focused decision support.
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Affiliation(s)
| | - Linda M. Kinney
- The Center for Program Design and Evaluation (CPDE), The Dartmouth Institute, Hanover, N.H
| | - Rebecca L. Butcher
- The Center for Program Design and Evaluation (CPDE), The Dartmouth Institute, Hanover, N.H
| | | | - Lee K. Brown
- Department of Surgery, Section of Urology, Dartmouth-Hitchcock Clinic, Lebanon, N.H
| | - Glyn Elwyn
- From the Geisel School of Medicine at Dartmouth, Hanover, N.H
- Coproduction Laboratory, The Dartmouth Institute, Hanover, N.H
| | - Jeremy B. Myers
- Division of Urology, Department of Surgery, University of Utah Health, Salt Lake City, Utah
| | - John H. Turco
- From the Geisel School of Medicine at Dartmouth, Hanover, N.H
- Department of Internal Medicine, Section of Endocrinology, Dartmouth-Hitchcock Clinic, Lebanon, N.H
| | - John F. Nigriny
- Department of Surgery, Section of Plastic Surgery, Dartmouth-Hitchcock Clinic, Lebanon, N.H
| | - Rachel A. Moses
- From the Geisel School of Medicine at Dartmouth, Hanover, N.H
- Department of Surgery, Section of Urology, Dartmouth-Hitchcock Clinic, Lebanon, N.H
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Abbatemarco JR, Cohen JA, Udeh BL, Bassi S, Rensel MR. Multiple Sclerosis Wellness Shared Medical Appointment Model: A Pilot Study. Int J MS Care 2021; 23:229-233. [PMID: 34720763 DOI: 10.7224/1537-2073.2020-044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Shared medical appointments (SMAs) are group medical visits combining medical care and patient education. We examined the impact of a wellness-focused pilot SMA in a large multiple sclerosis (MS) clinic. Methods We reviewed data on all patients who participated in the SMA from January 2016 through June 2019. The following data were collected 12 months pre/post SMA visits: demographics, body mass index, patient-reported outcomes, and health care utilization. Data were compared using the Wilcoxon rank sum test. Results Fifty adult patients (mean ± SD age, 50.1 ± 12.3 years) attended at least one MS wellness SMA. Most patients had private insurance (50%), and 26% had Medicaid coverage. The most common comorbidity was depression/anxiety (44%). Pre/post SMA outcomes showed a small but significant reduction in body mass index (30.2 ± 7.3 vs 28.8 ± 7.1, P = .03), and Patient Health Questionnaire-9 scores decreased from 7.3 ± 5.5 to 5.1 ± 5.6 (P = .001). The number of emergency department visits decreased from 13 to two (P = .0005), whereas follow-up visits increased with an attendees' primary care provider from 19 to 41 (P < .001), physical therapist from 15 to 27 (P = .004), and psychologist from six to 19 (P = .003). Conclusions This pilot MS wellness SMA was associated with improved physical and psychological outcomes. There was increased, lower-cost health care utilization with reduced acute, high-cost health care utilization, suggesting that SMAs may be a cost-effective and beneficial method in caring for patients with MS.
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Affiliation(s)
- Justin R Abbatemarco
- Cleveland Clinic Mellen Center for Multiple Sclerosis Treatment and Research (JRA, JAC, MRR), Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Jeffrey A Cohen
- Cleveland Clinic Mellen Center for Multiple Sclerosis Treatment and Research (JRA, JAC, MRR), Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Belinda L Udeh
- The Neurological Institute Center for Outcomes Research (BLU), Cleveland Clinic Foundation, Cleveland, OH, USA.,Quantitative Health Sciences, Lerner Research Institute, Cleveland, OH, USA (BLU)
| | - Sunakshi Bassi
- Case Western Reserve University School of Medicine, Cleveland, OH, USA (SB)
| | - Mary R Rensel
- Cleveland Clinic Mellen Center for Multiple Sclerosis Treatment and Research (JRA, JAC, MRR), Cleveland Clinic Foundation, Cleveland, OH, USA
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Tkachenko E, Refat MA, Balzano T, Maloney ME, Harris JE. Patient satisfaction and physician productivity in shared medical appointments for vitiligo. J Am Acad Dermatol 2019; 81:1150-1156. [DOI: 10.1016/j.jaad.2019.03.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/28/2019] [Accepted: 03/18/2019] [Indexed: 10/27/2022]
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Shared Medical Appointments in Preoperative Joint Replacement: Assessing Patient and Healthcare Member Satisfaction. J Healthc Qual 2019; 41:329-336. [PMID: 31082931 DOI: 10.1097/jhq.0000000000000205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Shared medical appointments (SMAs) have proven to be effective in improving patient access and education while augmenting productivity. In shifting from a traditional visit model, patient and interdisciplinary healthcare team (IHCT) member satisfaction is imperative. Predominantly seen in primary care, SMA use in orthopedics is limited. After identification of access and productivity concerns, the SMA was implemented as a quality improvement project in a rural clinic. The lower extremity joint replacement (LEJR) population was chosen because of multiple preoperative appointments and costs on the healthcare system. PURPOSE To assess patients' and IHCT members' satisfaction levels in using an SMA for the preparation of LEJR. RELEVANCE TO HEALTHCARE QUALITY The SMA is an effective model offering an efficient, cost-effective methodology aligning with the Institute for Healthcare Improvement's Triple Aim. RESULTS Twenty SMAs were conducted. Sixty-three patients and 14 ICHT members participated. Mean (M) satisfaction rating for SMA patients (M = 4.90, SD 0.26) was significantly higher than mean for traditional patients (M = 4.03, SD 0.39). Interdisciplinary healthcare team members' attitudes toward SMAs revealed a mean score of 4.58. Incidentally, cycle times improved as did lengths of stay. CONCLUSIONS Lower extremity joint replacement patients and IHCT members reported high satisfaction with SMAs.
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Parikh M, Rajendran I, D'Amico S, Luo M, Gardiner P. Characteristics and Components of Medical Group Visits for Chronic Health Conditions: A Systematic Scoping Review. J Altern Complement Med 2019; 25:683-698. [PMID: 30945935 DOI: 10.1089/acm.2018.0524] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objectives: Chronic health conditions are a major challenge to the health care system. Medical Group Visits (MGVs) are a valuable health care delivery model used in a variety of medical settings and patient populations. We conducted a systematic scoping review of MGV research literature for chronic health conditions to summarize the characteristics and individual components of MGVs in the United States of America and Canada. Design: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses scoping review methodology and searched five databases using nine widely used MGV-related terms. Subjects: We included studies conducted in the United States and Canada, whose participants were >18 years old and attended an MGV conducted in a medical setting by a billable health care provider. We excluded groups related to diabetes, pregnancy, and cancer. Results: Of 3777 studies identified, we found 55 eligible studies of which 9 are randomized controlled trials and 46 are observational studies. The majority of studies were conducted in academic medical centers, were observational in design, and recruited patients using physician referrals. The three most frequently studied groups include a combination of several chronic conditions (n = 12), chronic pain conditions (n = 10), and cardiovascular disease (n = 9). Curriculum components included didactics (n = 55), experiential activities (n = 27), and socializing components (n = 12). Didactic areas include (1) medical topics such as symptoms management (n = 27) of which 14 included pain management, and (2) lifestyle/educational component (n = 33) that comprised of talks on nutrition (n = 29), exercise (n = 20), stress (n = 16), and sleep (n = 10). The top integrative medicine (IM) modalities (n = 13) included: mindfulness techniques (n = 8), meditation (n = 6), and yoga (n = 5). Substantial heterogeneity was observed in the recruitment, implementation, curriculum components, and outcomes reported. Conclusion: The MGV is a model of patient-centered care that has captured the attention of researchers. IM modalities are well represented in the curriculum components of MGVs. Further investigation into the components identified by this study, may help in better targeting of group interventions to patients and contexts, where it is most likely to be effective.
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Affiliation(s)
- Manasi Parikh
- 1Department of Family Medicine and Boston Medical Center, Boston, MA
| | - Iniya Rajendran
- 2Department of Internal Medicine, Boston Medical Center, Boston, MA
| | - Salvatore D'Amico
- 1Department of Family Medicine and Boston Medical Center, Boston, MA
| | - Man Luo
- 1Department of Family Medicine and Boston Medical Center, Boston, MA
| | - Paula Gardiner
- 3Department of Family Medicine and Community Health, UMass Memorial Health Care, University of Massachusetts Medical School, Worcester, MA
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Kelly F, Liska C, Morash R, Hu J, Carroll SL, Shorr R, Dent S, Stacey D. Shared medical appointments for patients with a nondiabetic physical chronic illness: A systematic review. Chronic Illn 2019; 15:3-26. [PMID: 28927284 DOI: 10.1177/1742395317731608] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Shared medical appointments are group appointments, with an optional individual consultation, for patients diagnosed with chronic illnesses. Shared medical appointments improve diabetes management, but little is known about their use for other illnesses. The objective was to determine the effect that shared medical appointments have on patients with a physical chronic illness, healthcare providers, and the healthcare system. METHODS A systematic review was conducted searching databases from January 1970 to September 2016. Eligible trials evaluated shared medical appointments for patients with a homogeneous chronic illness, excluding diabetes and mental illness. Screening, data extraction, and risk of bias were conducted independently by two authors. Analysis was descriptive. RESULTS Of 2364 citations, nine randomized trials were included. Shared medical appointments were evaluated for cardiovascular illnesses (four studies), breast cancer, chronic kidney disease, Parkinson's disease, stress urinary incontinence, and carpal tunnel syndrome. Compared to usual care, no negative effects on patient quality of life, knowledge and satisfaction were reported. One study reported no difference in healthcare provider satisfaction. Another study showed fewer hospital admissions for patients who attended shared medical appointments. DISCUSSION Few rigorous studies evaluated the use of shared medical appointments for chronic illnesses. Overall, there appears to be no patient harms. Further studies should include more objective outcomes and larger sample sizes.
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Affiliation(s)
- F Kelly
- 1 School of Nursing, University of Ottawa, Ottawa, Ontario, Canada.,2 Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - C Liska
- 3 The Ottawa Hospital, Ottawa, Ontario, Canada
| | - R Morash
- 3 The Ottawa Hospital, Ottawa, Ontario, Canada
| | - J Hu
- 1 School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - S L Carroll
- 4 School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - R Shorr
- 3 The Ottawa Hospital, Ottawa, Ontario, Canada
| | - S Dent
- 3 The Ottawa Hospital, Ottawa, Ontario, Canada
| | - D Stacey
- 1 School of Nursing, University of Ottawa, Ottawa, Ontario, Canada.,2 Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Giramonti KM, Kogan BA. Early experience with shared medical appointments for penile problems. J Pediatr Urol 2018; 14:81-83. [PMID: 29191660 DOI: 10.1016/j.jpurol.2017.09.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/29/2017] [Indexed: 11/17/2022]
Abstract
We examined the use of shared medical appointments (SMA) for educating and counseling children with penile problems. Forty-eight families were seen over 4 months with 21 participating in the SMA group and 27 in the traditional group. Using a questionnaire to assess adequacy of education, there was no difference in the overall scores between groups with a mean of 6.64/7 in the SMA and 6.56/7 in the traditional setting. With the increasing demands on providers, an SMA offers a solution to caring for more patients with penile problems in an efficient manner without impacting family education and satisfaction.
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Affiliation(s)
| | - Barry A Kogan
- Albany Medical Center Division of Urology, Albany, NY, USA
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