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Cavallo DA, Salwan JK, Doernberg M, Tetrault JM, Holt SR. Shared Medical Appointment: A Novel Model for Incorporating Group Visits Into Residency Training for Substance Use Disorders. SUBSTANCE USE & ADDICTION JOURNAL 2024; 45:466-472. [PMID: 38494709 DOI: 10.1177/29767342241233363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
BACKGROUND Shared medical appointments (SMAs) are a novel modality for treating patients with similar conditions, together, by a team of interdisciplinary providers. SMAs benefit patients with substance use disorder (SUD), but no research has focused on the feasibility of implementation of SMAs in a teaching clinic. METHODS Primary care residents rotated in a half-day ambulatory addiction clinic for 4 weeks where a third-year resident co-facilitated 4 SMAs. Confidence, knowledge, and attitudes about SUD care were assessed using web-based surveys at weeks 0, 4, and 8. Pre- and post-intervention scores were compared using a t test for paired samples. RESULTS Ten residents were included in the analyses. Using a 10-point Likert scale, confidence in SUD knowledge (7.0-8.3, P = .003), confidence in counseling patients with SUD (7.1-8.2, P = .023), and confidence in facilitating an SMA (5.7-8.3, P = .007) showed statistically significant increases from baseline following exposure to the SMAs. Confidence that counseling and other treatments will make a difference for patients with illicit drug use increased (7.1-8.0, P = .142), but did not differ statistically. Furthermore, on a 4-point Likert scale, understanding of behavioral therapies for treating and preventing the relapse of SUD (2.9-3.2, P = .180) showed a similar increase. Attitudes toward patients with SUD (42.4-42.1, P = .303) and physician empathy (119.3-119.2, P = .963) did not change from pre- to post-intervention. CONCLUSIONS SMAs are a feasible training tool in the education of primary care residents on an addiction medicine rotation. Residents develop confidence co-facilitating SMAs after 4 weeks. Overall, exposure to SMAs during residency can provide an opportunity to increase confidence in treating patients with SUD, as well as provide a training modality that may shift the way residents interact with patients receiving SUD treatment.
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Affiliation(s)
- Dana A Cavallo
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Jasleen K Salwan
- Internal Medicine and Addiction Medicine, Montgomery Family Medicine Associates, Silver Spring, MD, USA
| | | | - Jeanette M Tetrault
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Stephen R Holt
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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Kirbach K, Marshall-Moreno I, Shen A, Cullen C, Sanigepalli S, Bobadilla A, MacElhern L, Grunvald E, Kallenberg G, Tristão Parra M, Sannidhi D. Implementation of a virtual, shared medical appointment program that focuses on food as medicine principles in a population with obesity: the SLIM program. Front Nutr 2024; 11:1338727. [PMID: 38962444 PMCID: PMC11220244 DOI: 10.3389/fnut.2024.1338727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 05/24/2024] [Indexed: 07/05/2024] Open
Abstract
Background Multimodal lifestyle interventions, employing food as medicine, stand as the recommended first-line treatment for obesity. The Shared Medical Appointment (SMA) model, where a physician conducts educational sessions with a group of patients sharing a common diagnosis, offers an avenue for delivery of comprehensive obesity care within clinical settings. SMAs, however, are not without implementation challenges. We aim to detail our experience with three implementation models in launching a virtual integrative health SMA for weight management. Methods Eligible patients included individuals 18 years of age or older, having a body mass index (BMI) of 30 kg/m2 or 27 kg/m2 or greater with at least one weight related comorbidity. The Practical, Robust Implementation and Sustainability Model (PRISM), Plan, Do, Study, Act (PDSA), and the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) models were applied to guide the implementation of the Supervised Lifestyle Integrative Medicine (SLIM) program, a virtually delivered, lifestyle medicine focused SMA program, in a weight management clinic within a major health system. We describe how these models, along with attendance for the initial cohorts, were used for decision-making in the process of optimizing the program. Results 172 patients completed the SLIM program over two years. Attendance was lowest for sessions held at 8:00 AM and 4:00 PM compared to sessions at 10:00 AM, 1:00 PM, and 3:00 PM, leading to only offering midday sessions (p = 0.032). Attendance data along with feedback from patients, facilitators, and administrative partners led to changes in the curriculum, session number and frequency, session reminder format, and intake visit number. Conclusion The use of implementation and quality improvement models provided crucial insight for deployment and optimization of a virtual, lifestyle medicine focused SMA program for weight management within a large healthcare system.
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Affiliation(s)
- Kyleigh Kirbach
- School of Medicine, University of California San Diego, San Diego, CA, United States
| | | | - Alice Shen
- School of Medicine, University of California San Diego, San Diego, CA, United States
| | - Curtis Cullen
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, United States
| | | | - Alejandra Bobadilla
- Center for Integrative Medicine, University of California San Diego, San Diego, CA, United States
| | - Lauray MacElhern
- Center for Integrative Medicine, University of California San Diego, San Diego, CA, United States
| | - Eduardo Grunvald
- Bariatric and Metabolic Institute, University of California San Diego, San Diego, CA, United States
| | - Gene Kallenberg
- Center for Integrative Medicine, University of California San Diego, San Diego, CA, United States
| | | | - Deepa Sannidhi
- Department of Family Medicine, University of California San Diego, San Diego, CA, United States
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Schmid B, Njeim C, Vijayasingham L, Sanga LA, Naimi RK, Fouad FM, Akik C, Zmeter C, Perone SA, Larsen LB, Roswall J, Ansbro É, Perel P. Implementing (and evaluating) peer support with people living with noncommunicable diseases in humanitarian settings. J Migr Health 2024; 9:100229. [PMID: 38633280 PMCID: PMC11021823 DOI: 10.1016/j.jmh.2024.100229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
In line with the peer reviewers comments, the authors have added highlights in stead of an abstract. It was felt that it was better able to capture the findings and is more in line with the paper's target audience.
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Affiliation(s)
- Benjamin Schmid
- Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Lavanya Vijayasingham
- Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Leah Anku Sanga
- Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | | | - Carla Zmeter
- International Committee of the Red Cross, Beirut, Lebanon
| | - Sigiriya Aebischer Perone
- International Committee of the Red Cross, Geneva, Switzerland
- Geneva University Hospitals, Geneva, Switzerland
| | | | | | - Éimhín Ansbro
- Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Pablo Perel
- Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Tang MY, Graham F, O'Donnell A, Beyer F, Richmond C, Dhami R, Sniehotta FF, Kaner EFS. Effectiveness of shared medical appointments delivered in primary care for improving health outcomes in patients with long-term conditions: a systematic review of randomised controlled trials. BMJ Open 2024; 14:e067252. [PMID: 38453205 PMCID: PMC10921542 DOI: 10.1136/bmjopen-2022-067252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 02/21/2024] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVES To examine the effectiveness of shared medical appointments (SMAs) compared with one-to-one appointments in primary care for improving health outcomes and reducing demand on healthcare services by people with one or more long-term conditions (LTCs). DESIGN A systematic review of the published literature. DATA SOURCES Six databases, including MEDLINE and Web of Science, were searched 2013-2023. Relevant pre-2013 trials identified by forward and backward citation searches of the included trials were included. ELIGIBILITY CRITERIA Randomised controlled trials of SMAs delivered in a primary care setting involving adults over 18 years with one or more LTCs. Studies were excluded if the SMA did not include one-to-one patient-clinician time. All countries were eligible for inclusion. DATA EXTRACTION AND SYNTHESIS Data were extracted and outcomes narratively synthesised, meta-analysis was undertaken where possible. RESULTS Twenty-nine unique trials were included. SMA models varied in terms of components, mode of delivery and target population. Most trials recruited patients with a single LTC, most commonly diabetes (n=16). There was substantial heterogeneity in outcome measures. Meta-analysis showed that participants in SMA groups had lower diastolic blood pressure than those in usual care (d=-0.086, 95% CI=-0.16 to -0.02, n=10) (p=0.014). No statistically significant differences were found across other outcomes. Compared with usual care, SMAs had no significant effect on healthcare service use. For example, no difference between SMAs and usual care was found for admissions to emergency departments at follow-up (d=-0.094, 95% CI=-0.27 to 0.08, n=6, p=0.289). CONCLUSIONS There was a little difference in the effectiveness of SMAs compared with usual care in terms of health outcomes or healthcare service use in the short-term (range 12 weeks to 24 months). To strengthen the evidence base, future studies should include a wider array of LTCs, standardised outcome measures and more details on SMA components to help inform economic evaluation. PROSPERO REGISTRATION NUMBER CRD42020173084.
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Affiliation(s)
- Mei Yee Tang
- NIHR Policy Research Unit in Behavioural Science, Newcastle University, Newcastle upon Tyne, UK
- School of Psychology, University of Leeds, Leeds, UK
| | - Fiona Graham
- NIHR Policy Research Unit in Behavioural Science, Newcastle University, Newcastle upon Tyne, UK
| | - Amy O'Donnell
- NIHR Policy Research Unit in Behavioural Science, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona Beyer
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Catherine Richmond
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Raenhha Dhami
- NIHR Policy Research Unit in Behavioural Science, Newcastle University, Newcastle upon Tyne, UK
- Department of Public Health, Preventive and Social Medicine, Heidelberg University, Mannheim, Germany
| | - Falko F Sniehotta
- NIHR Policy Research Unit in Behavioural Science, Newcastle University, Newcastle upon Tyne, UK
- Department of Public Health, Preventive and Social Medicine, Heidelberg University, Mannheim, Germany
| | - Eileen F S Kaner
- NIHR Policy Research Unit in Behavioural Science, Newcastle University, Newcastle upon Tyne, UK
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Lenze SN, McKay-Gist K, Paul R, Tepe M, Mathews K, Kornfield S, Phillips C, Smith R, Stoermer A, Carter EB. Elevating Voices, Addressing Depression, Toxic Stress, and Equity Through Group Prenatal Care: A Pilot Study. Health Equity 2024; 8:87-95. [PMID: 38287981 PMCID: PMC10823176 DOI: 10.1089/heq.2023.0160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2023] [Indexed: 01/31/2024] Open
Abstract
Introduction Elevating Voices, Addressing Depression, Toxic Stress and Equity (EleVATE) is a group prenatal care (GC) model designed to improve pregnancy outcomes and promote health equity for Black birthing people. This article outlines the foundational community-engaged process to develop EleVATE GC and pilot study results. Methods We used community-based participatory research principles and the Ferguson Commission Report to guide creation of EleVATE GC. The intervention, designed by and for Black birthing people, centers trauma-informed care, antiracism, and integrates behavioral health strategies into group prenatal care to address unmet mental health needs. Using a convenience sample of patients seeking care at one of three safety-net health care sites, we compared preterm birth, small for gestational age, depression scores, and other pregnancy outcomes between patients in individual care (IC), CenteringPregnancy™ (CP), and EleVATE GC. Results Forty-eight patients enrolled in the study (n=11 IC; n=14 CP; n=23 EleVATE GC) and 86% self-identified as Black. Patients participating in group prenatal care (EleVATE GC or CP) were significantly less likely to experience a preterm birth <34 weeks. Rates of small for gestational age, preterm birth <37 weeks, depression scores, and other pregnancy outcomes were similar across groups. Participants in CP and EleVATE GC were more likely to attend their postpartum visit and breastfeed at hospital discharge than those in IC. Discussion Our findings model a systematic approach to design a feasible, patient-centered, community-based, trauma-informed, antiracist intervention. Further study is needed to determine whether EleVATE GC improves perinatal outcomes and promotes health equity.
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Affiliation(s)
- Shannon N. Lenze
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Rachel Paul
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Katherine Mathews
- SSM Health St. Mary's and Department of Obstetrics, Gynecology, and Women's Health, St. Louis University, St. Louis, Missouri, USA
| | - Sara Kornfield
- Center for Women's Behavioral Wellness, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cheron Phillips
- St. Louis Integrated Health Network, St. Louis, Missouri, USA
| | - Richelle Smith
- St. Louis Integrated Health Network, St. Louis, Missouri, USA
| | - Amanda Stoermer
- St. Louis Integrated Health Network, St. Louis, Missouri, USA
| | - Ebony B. Carter
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri, USA
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Greenberg B, Oft AC, Lucitt L, Haug NA, Lembke A. Qualitative exploration of the psychological dimensions of telehealth shared medical appointments (SMAs) for buprenorphine prescribing. J Addict Dis 2024; 42:14-23. [PMID: 36374272 DOI: 10.1080/10550887.2022.2123669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Shared medical appointments (SMAs) for buprenorphine prescribing are clinical encounters in which multiple patients with opioid problems receive treatment from providers in a group setting. Telehealth, the provision of clinical services remotely using telecommunications technology, is an essential modality for improving access to healthcare when combined with SMAs, especially since the COVID pandemic. Objectives: The current study specifically examined psychological components of telehealth SMAs for buprenorphine prescribing to learn about the benefits and drawbacks of this treatment model. Methods: Data was collected through qualitative interviews with patients (N=10) in a psychiatry addiction medicine clinic. Narrative synthesis using grounded theory was conducted to identify salient themes from the interviews. Results: Findings highlighted the advantages and downsides of telehealth SMA to treat addictive disorders in a digital age: (1) Shared group identity; (2) Decreased stigma around buprenorphine; (3) Benefits of telehealth; (4) Discomfort with group SMA format; (5) Strategies for managing medication side effects; and (6) Enhanced empathy for providers. Several themes corresponded to therapeutic factors identified in group therapy (i.e., installation of hope, universality, imparting information, altruism) and mechanisms theorized in previous SMA research (e.g., combating isolation, disease self-management, feeling inspired by others). Conclusion: Telehealth SMAs for buprenorphine prescribing may be a unique opportunity for patients to receive both ongoing medication management and psychosocial benefits that promote recovery and reduce stigma. The SMA group had shortcomings for some patients, including privacy concerns, fear of judgment from other patients and limited time to discuss individual concerns with providers.
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Affiliation(s)
- Ben Greenberg
- PGSP-Stanford PsyD Consortium, Department of Psychology, Palo Alto University, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Anna C Oft
- Georgetown University, Washington, DC, USA
| | - Lauren Lucitt
- PGSP-Stanford PsyD Consortium, Department of Psychology, Palo Alto University, Palo Alto, CA, USA
| | - Nancy A Haug
- PGSP-Stanford PsyD Consortium, Department of Psychology, Palo Alto University, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Anna Lembke
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
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Loy MH, Prisco L, Parikh C. Implementation of Virtual Integrative Oncology Shared Medical Appointment Series (VIOSMAS) Within Mixed Diagnosis Population. Integr Cancer Ther 2024; 23:15347354231223969. [PMID: 38243739 PMCID: PMC10799580 DOI: 10.1177/15347354231223969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 11/09/2023] [Accepted: 12/15/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Integrative oncology [IO] is sought-after by patients, endorsed by clinical guidelines, and valued within National Cancer Institute Centers. Shared Medical Appointments [SMA] leverage health education and social connection to deliver enhanced patient experience, population health, cost-reduction, and clinician well-being. Integrative Oncology Shared Medical Appointments increase access to integrative medicine but delivering these services via telehealth have not been evaluated. OBJECTIVE We created, and pilot tested a Virtual Integrative Oncology Shared Medical Appointment Series (VIOSMAS) to assess its feasibility, acceptability, and efficacy at an urban academic teaching hospital. METHODS The 7-session hour-long Living Well with and after Cancer series included didactics, multi-disciplinary experiential sessions, and group discussion. Topics included (1) Introduction, (2) Herbs/Botanicals/Fungi, (3) Mindful Movement, (4) Acupuncture, (5) Narratives and Nature, (6) Diet and Culinary Medicine, and (7) Vitamins/Supplements. Virtual visits via telehealth were offered to enhance patient participation during the pandemic. Outcome measures included recruitment, retention, pre/post-series patient survey and qualitative clinician feedback. RESULTS Between 9/2021 and 4/2023, 72 unique patients were recruited to 5 cohorts and had a total of 332 VIOSMAS visits. A total of 50 patients (69%) attended 4 or more of the 7-session series; 60 (83% were women); patients ranged in age from 28 to 93 years (median 66); 36 (50%) lived outside the city center; the most common cancer diagnoses were breast, lymphoma, and lung cancer. Patients were from diverse demographics. Pre-program, patients reported desiring assistance in addressing diverse symptoms including fatigue, insomnia, pain, gastrointestinal (GI) symptoms, anxiety, and depression. Post-series, patients reported that the VIOSMAS addressed their goals and symptoms; they also reported incorporating recommended lifestyle changes in diet, exercise, sleep, and stress management; they were satisfied with the number of sessions and telehealth format. The participating clinicians reported high levels of satisfaction with VIOSMAS. Revenue to the institution from VIOSMAS exceeded the revenue potential of equivalent time spent for individual visits while supporting extended physician-patient contact. CONCLUSION VIOSMAS is feasible for patients and clinicians, addresses patients' symptoms and questions about lifestyle and complementary therapies, and generates more revenue than individual visits. Larger implementation trials with appropriate comparison groups are recommended.
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Affiliation(s)
- Michelle H. Loy
- Cornell University, New York, NY, USA
- Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
| | | | - Chiti Parikh
- Cornell University, New York, NY, USA
- Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
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McDermott K, Levey N, Brewer J, Ehmann M, Hooker JE, Pasinski R, Yousif N, Raju V, Gholston M, Greenberg J, Ritchie CS, Vranceanu AM. Improving Health for Older Adults With Pain Through Engagement: Protocol for Tailoring and Open Pilot Testing of a Mind-Body Activity Program Delivered Within Shared Medical Visits in an Underserved Community Clinic. JMIR Res Protoc 2023; 12:e52117. [PMID: 38157234 PMCID: PMC10787331 DOI: 10.2196/52117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Chronic musculoskeletal pain is prevalent and disabling among older adults in underserved communities. Psychosocial pain management is more effective than pharmacological treatment in older adults. However, underserved community clinics often lack psychosocial treatments, in part because of a lack of trained providers. Shared medical appointments, in which patients undergo brief medical evaluation, monitoring, counseling, and group support, are an efficacious and cost-effective method for chronic disease management in underserved clinics, reducing the need for specialized providers. However, shared medical visits are often ineffective for chronic pain, possibly owing to lack of inclusion of skills most relevant for older adults (eg, pacing to increase engagement in daily activities). OBJECTIVE We have described the protocol for the development and initial pilot effectiveness testing of the GetActive+ mind-body activity intervention for older adults with chronic pain. GetActive+ was adapted from GetActive, an evidence-based intervention that improved pain outcomes among mostly affluent White adults. We aim to establish the initial feasibility, acceptability, fidelity, and effectiveness of GetActive+ when delivered as part of shared medical appointments in a community clinic. METHODS We conducted qualitative focus groups and individual interviews with providers (n=25) and English-speaking older adults (aged ≥55 y; n=18) with chronic pain to understand the pain experience in this population, perceptions about intervention content, and barriers to and facilitators of intervention participation and implementation in this setting. Qualitative interviews with Spanish-speaking older adults are in progress and will inform a future open pilot of the intervention in Spanish. We are currently conducting an open pilot study with exit interviews in English (n=30 individuals in total). Primary outcomes are feasibility (≥75% of patients who are approached agree to participate), acceptability (≥75% of patients who enrolled complete 8 out of 10 sessions; qualitative), and fidelity (≥75% of session components are delivered as intended). Secondary outcomes include physical function-self-reported, performance based (6-minute walk test), and objective (step count)-and emotional function (depression and anxiety). Other assessments include putative mechanisms (eg, mindfulness and pain catastrophizing). RESULTS We began enrolling participants for the qualitative phase in November 2022 and the open pilot phase in May 2023. We completed the qualitative phase with providers and English-speaking patients, and the results are being analyzed using a hybrid, inductive-deductive approach. We conducted rapid analysis of these data to develop GetActive+ before the open pilot in English, including increasing readability and clarity of language, reducing the number of skills taught to increase time for individual check-ins and group participation, and increasing experiential exercises for skill uptake. CONCLUSIONS We provide a blueprint for the refinement of a mind-body activity intervention for older adults with chronic pain in underserved community clinics and for incorporation within shared medical visits. It will inform a future, fully powered, effectiveness-implementation trial of GetActive+ to help address the chronic pain epidemic among older adults. TRIAL REGISTRATION ClinicalTrials.gov NCT05782231; https://clinicaltrials.gov/study/NCT05782231. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52117.
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Affiliation(s)
- Katherine McDermott
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Nadine Levey
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Julie Brewer
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Madison Ehmann
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Julia E Hooker
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Roger Pasinski
- Massachusetts General Hospital Revere HealthCare Center, Revere, MA, United States
| | - Neda Yousif
- Massachusetts General Hospital Revere HealthCare Center, Revere, MA, United States
| | - Vidya Raju
- Massachusetts General Hospital Revere HealthCare Center, Revere, MA, United States
| | - Milton Gholston
- Massachusetts General Hospital Revere HealthCare Center, Revere, MA, United States
| | - Jonathan Greenberg
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Christine S Ritchie
- Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, MA, United States
| | - Ana-Maria Vranceanu
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
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Mathiesen AS, Zoffmann V, Lindschou J, Jakobsen JC, Gluud C, Due-Christensen M, Rasmussen B, Marqvorsen EHS, Lund-Jacobsen T, Skytte TB, Thomsen T, Rothmann MJ. Self-determination theory interventions versus usual care in people with diabetes: a systematic review with meta-analysis and trial sequential analysis. Syst Rev 2023; 12:158. [PMID: 37674180 PMCID: PMC10483731 DOI: 10.1186/s13643-023-02308-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 08/04/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Autonomy-supporting interventions, such as self-determination theory and guided self-determination interventions, may improve self-management and clinical and psychosocial outcomes in people with diabetes. Such interventions have never been systematically reviewed assessing both benefits and harms and concurrently controlling the risks of random errors using trial sequential analysis methodology. This systematic review investigates the benefits and harms of self-determination theory-based interventions compared to usual care in people with diabetes. METHODS We used the Cochrane methodology. Randomized clinical trials assessing interventions theoretically based on guided self-determination or self-determination theory in any setting were eligible. A comprehensive search (latest search April 2022) was undertaken in CENTRAL, MEDLINE, Embase, LILACS, PsycINFO, SCI-EXPANDED, CINAHL, SSCI, CPCI-S, and CPCI-SSH to identify relevant trials. Two authors independently screened, extracted data, and performed risk-of-bias assessment of included trials using the Cochrane risk-of-bias tool 1.0. Our primary outcomes were quality of life, all-cause mortality, and serious adverse events. Our secondary outcomes were diabetes distress, depressive symptoms, and nonserious adverse events not considered serious. Exploratory outcomes were glycated hemoglobin and motivation (autonomy, controlled, amotivation). Outcomes were assessed at the end of the intervention (primary time point) and at maximum follow-up. The analyses were conducted using Review Manager 5.4 and Trial Sequential Analysis 0.9.5.10. Certainty of the evidence was assessed by GRADE. RESULTS Our search identified 5578 potentially eligible studies of which 11 randomized trials (6059 participants) were included. All trials were assessed at overall high risk of bias. We found no effect of self-determination theory-based interventions compared with usual care on quality of life (mean difference 0.00 points, 95% CI -4.85, 4.86, I2 = 0%; 225 participants, 3 trials, TSA-adjusted CI -11.83, 11.83), all-cause mortality, serious adverse events, diabetes distress, depressive symptoms, adverse events, glycated hemoglobulin A1c, or motivation (controlled). The certainty of the evidence was low to very low for all outcomes. We found beneficial effect on motivation (autonomous and amotivation; low certainty evidence). CONCLUSIONS We found no effect of self-determination-based interventions on our primary or secondary outcomes. The evidence was of very low certainty. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020181144.
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Affiliation(s)
- Anne Sophie Mathiesen
- Department of Endocrinology, Center for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark.
- The Interdisciplinary Research Unit of Women's, Children's and Families' Health, the Julie Marie Center, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, Copenhagen, 2100, Denmark.
| | - Vibeke Zoffmann
- The Interdisciplinary Research Unit of Women's, Children's and Families' Health, the Julie Marie Center, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, Copenhagen, 2100, Denmark
- Sector of Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Faculty of Health, School of Nursing and Midwifery, Deakin University, Melbourne, Australia
| | - Jane Lindschou
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital - Rigshospitalet, The Capital Region, Copenhagen, Denmark
| | - Janus Christian Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital - Rigshospitalet, The Capital Region, Copenhagen, Denmark
- Department of Regional Health Research, The Faculty of Heath Sciences, University of Southern Denmark, Odense, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital - Rigshospitalet, The Capital Region, Copenhagen, Denmark
- Department of Regional Health Research, The Faculty of Heath Sciences, University of Southern Denmark, Odense, Denmark
| | - Mette Due-Christensen
- Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
- Steno Diabetes Center Copenhagen, The Capital Region of Denmark, Herlev, Denmark
| | - Bodil Rasmussen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Sector of Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Faculty of Health, School of Nursing and Midwifery, Deakin University, Melbourne, Australia
| | - Emilie Haarslev Schröder Marqvorsen
- The Interdisciplinary Research Unit of Women's, Children's and Families' Health, the Julie Marie Center, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, Copenhagen, 2100, Denmark
| | - Trine Lund-Jacobsen
- Department of Endocrinology, Center for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Tine Bruhn Skytte
- The Interdisciplinary Research Unit of Women's, Children's and Families' Health, the Julie Marie Center, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, Copenhagen, 2100, Denmark
| | - Thordis Thomsen
- Department of Anaesthesiology, Department of Clinical Medicine, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mette Juel Rothmann
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Faculty of Health, School of Nursing and Midwifery, Deakin University, Melbourne, Australia
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
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Palay J, Bolton JM, Sareen J, Hensel JM. Increasing access to specialist care with group medical visits: summary of a pilot in a post-crisis psychiatric clinic. FRONTIERS IN HEALTH SERVICES 2023; 3:1127725. [PMID: 37435511 PMCID: PMC10332818 DOI: 10.3389/frhs.2023.1127725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 06/14/2023] [Indexed: 07/13/2023]
Abstract
Background Group medical visits (GMVs) have strong evidence of acceptability and effectiveness in the management of chronic medical diseases. Adaptation of GMVs for psychiatric care has potential to increase access, decrease stigma and save costs. Despite promise, this model has not been widely adopted. Methods A novel GMV pilot was implemented for psychiatric care post-crisis among patients with primary mood or anxiety disorders who required medication management. Participants filled out PHQ-9 and GAD-7 scales at each visit in order to track their progress. After discharge, charts were reviewed for demographics, medication changes and symptom changes. Patient characteristics were compared between those who attended and those who didn't. Changes in total PHQ-9 and GAD-7 scores among attendees were assessed with paired t-tests. Results Forty-eight patients were enrolled between October 2017 and the end of December 2018, 41 of whom consented to participate. Of those, 10 did not attend, 8 attended but did not complete, and 23 completed. Baseline PHQ-9 and GAD-7 scores did not differ significantly between groups. Significant and meaningful reductions in PHQ-9 and GAD-7 scores from baseline to last visit attended occurred among those who attended at least 1 visit (decrease of 5.13 and 5.26 points, respectively). Conclusions This GMV pilot demonstrated feasibility of the model as well as positive outcomes for patients recruited in a post-crisis setting. This model has the potential to increase access to psychiatric care in the face of limited resources, however the failure of the pilot to sustain highlights challenges to be addressed in future pivots.
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Gerontakos S, Leach M, Steel A, Wardle J. Feasibility and efficacy of implementing group visits for women's health conditions: a systematic review. BMC Health Serv Res 2023; 23:549. [PMID: 37237255 DOI: 10.1186/s12913-023-09582-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Shared medical appointments, also known as group visits, are a feasible and well-accepted approach for women receiving antenatal care, yet the feasibility and efficacy of this approach for female-specific reproductive conditions is uncertain. OBJECTIVE The aim of this systematic review was to (a) determine the feasibility of group visits in adults with any female-specific reproductive condition, and (b) identify whether delivering group care for these conditions impacts clinical outcomes. METHOD Six databases and two clinical trials registries were searched from inception through to 26 January 2022 for original research examining group medical visits or group consultation interventions for adults with female reproductive conditions or pathologic conditions specific to the female reproductive system. RESULTS The search yielded 2584 studies, of which four met the inclusion criteria. Included studies sampled women with breast cancer, chronic pelvic pain, polycystic ovary syndrome and gynaecological cancers. Studies reported high levels of patient satisfaction, with participants indicating their expectations had been met or exceeded. The impact of group visits on clinical outcomes was inconclusive however. DISCUSSION/CONCLUSIONS The studies in this review indicate delivery of female-specific healthcare via a group model maybe feasible and well-accepted. The review provides a solid basis for proposing larger and longer studies on group visits for female reproductive conditions. TRIAL REGISTRATION The review protocol was registered with PROSPERO (CRD42020196995).
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Affiliation(s)
- Sophia Gerontakos
- National Centre for Naturopathic Medicine, Southern Cross University, A Block, Military Road, Lismore, NSW, 2480, Australia.
| | - Matthew Leach
- National Centre for Naturopathic Medicine, Southern Cross University, A Block, Military Road, Lismore, NSW, 2480, Australia
| | - Amie Steel
- Faculty of Health, University of Technology Sydney, Australian Research Centre in Complementary and Integrative Medicine, Broadway, NSW, Australia
| | - Jon Wardle
- National Centre for Naturopathic Medicine, Southern Cross University, A Block, Military Road, Lismore, NSW, 2480, Australia
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Wegner E, Cheng A, Johnson C, Carbone A, Florio N, Washington JC. Evaluating Diabetes Group Medical Visits in a Family Medicine Residency Program. PRIMER (LEAWOOD, KAN.) 2023; 7:128268. [PMID: 36845842 PMCID: PMC9957450 DOI: 10.22454/primer.2023.128268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Group medical visits (GMV) have been shown to improve metrics in patients with type 2 diabetes mellitus (DM). Overlook Family Medicine, a teaching residency program, anticipated that medical residents trained in the GMV model of care by interdisciplinary team members may improve cholesterol, HbA1C, BMI, and blood pressure in patients. The objective of this study was to compare metrics between group 1: GMV patients with DM whose primary care provider (PCP) was an attending physician/nurse practitioner (NP) and group 2: GMV patients with DM whose PCP was a family medicine (FM) medical resident receiving GMV training. We seek to provide guidance on implementation of GMV in residency teaching practices. Methods We performed a retrospective analysis to evaluate total cholesterol, LDL, HDL, TG, BMI, HbA1C, and BP in GMV patients between 2015-2018. We used a t test to compare outcomes between the two groups. Diabetes training was provided to family medicine residents by an interdisciplinary team. Results There were 113 patients enrolled in the study: 53 in group 1 and 60 in group 2. There was a statistically significant decrease in LDL and triglycerides, and an increase in HDL in group 2 (P<.05). There was a clinically significant decrease in HbA1C in group 2 (-0.56, P=.0622). Conclusion Sustainability of GMV can be achieved with a champion diabetes education specialist. Interdisciplinary team members are integral in training residents and addressing patients' barriers. GMV training should be incorporated into family medicine residency programs to improve metrics for patients with diabetes. FM residents who received interdisciplinary training had improved metrics in GMV patients compared to patients whose providers did not. Therefore, GMV training should be incorporated into family medicine residency programs to improve metrics for patients with diabetes.
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Affiliation(s)
| | | | | | - Antonia Carbone
- Fairleigh Dickinson University of Pharmacy & Health Sciences, Florham Park, NJ
| | - Nick Florio
- Larner College of Medicine at The University of Vermont, Burlington, VT
| | - Judy C. Washington
- Overlook Family Medicine Residency Program, Summit, NJ
- Atlantic Medical Group, Morristown, NJ
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13
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Nederveld A, Phimphasone-Brady P, Gurfinkel D, Waxmonsky JA, Kwan BM, Holtrop JS. Delivering diabetes shared medical appointments in primary care: early and mid-program adaptations and implications for successful implementation. BMC PRIMARY CARE 2023; 24:52. [PMID: 36803773 PMCID: PMC9936115 DOI: 10.1186/s12875-023-02006-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/09/2023] [Indexed: 02/19/2023]
Abstract
BACKGROUND Self-management is essential for good outcomes in type 2 diabetes and patients often benefit from self-management education. Shared medical appointments (SMAs) can increase self-efficacy for self management but are difficult for some primary care practices to implement. Understanding how practices adapt processes and delivery of SMAs for patients with type 2 diabetes may provide helpful strategies for other practices interested in implementing SMAs. METHODS The Invested in Diabetes study was a pragmatic cluster-randomized, comparative effectiveness trial designed to compare two different models of diabetes SMAs delivered in primary care. We used a multi-method approach guided by the FRAME to assess practices' experience with implementation, including any planned and unplanned adaptations. Data sources included interviews, practice observations and field notes from practice facilitator check-ins. RESULTS Several findings were identified from the data: 1) Modifications and adaptations are common in implementation of SMAs, 2) while most adaptations were fidelity-consistent supporting the core components of the intervention conditions as designed, some were not, 3) Adaptations were perceived to be necessary to help SMAs meet patient and practice needs and overcome implementation challenges, and 4) Content changes in the sessions were often planned and enacted to better address the contextual circumstances such as patient needs and culture. DISCUSSION Implementing SMAs in primary care can be challenging and adaptations of both implementation processes and content and delivery of SMAS for patients with type 2 diabetes were common in the Invested in Diabetes study. Recognizing the need for adaptations based on practice context prior to implementation may help improve fit and success with SMAs, but care needs to be given to ensure that adaptations do not weaken the impact of the intervention. Practices may be able to assess what might need to adapted for them to be successful prior to implementation but likely will continue to adapt after implementation. CONCLUSION Adaptations were common in the Invested in Diabetes study. Practices may benefit from understanding common challenges in implementing SMAs and adapting processes and delivery based on their own context. TRIAL REGISTRATION This trial is registered on clinicaltrials.gov under Trial number NCT03590041, posted 18/07/2018.
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Affiliation(s)
- Andrea Nederveld
- Department of Family Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, 80045, USA.
| | - Phoutdavone Phimphasone-Brady
- grid.430503.10000 0001 0703 675XDepartment of Psychiatry, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045 USA
| | - Dennis Gurfinkel
- grid.430503.10000 0001 0703 675XAdult and Child Center for Outcomes Research and Delivery Science, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045 USA
| | - Jeanette A. Waxmonsky
- grid.430503.10000 0001 0703 675XDepartment of Family Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045 USA ,grid.430503.10000 0001 0703 675XAdult and Child Center for Outcomes Research and Delivery Science, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045 USA
| | - Bethany M. Kwan
- grid.430503.10000 0001 0703 675XAdult and Child Center for Outcomes Research and Delivery Science, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045 USA ,grid.430503.10000 0001 0703 675XDeparment of Emergency Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045 USA
| | - Jodi Summers Holtrop
- grid.430503.10000 0001 0703 675XDepartment of Family Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045 USA ,grid.430503.10000 0001 0703 675XAdult and Child Center for Outcomes Research and Delivery Science, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045 USA
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Pearsons A, Neubeck L, Hendriks JM, Hanson CL. Justification, rationale and methodological approaches to realist reviews. Eur J Cardiovasc Nurs 2023; 22:107-112. [PMID: 35881526 DOI: 10.1093/eurjcn/zvac068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 01/14/2023]
Abstract
Realist reviews offer a method to understand why an intervention is successful or not. Many factors influence how complex healthcare interventions are delivered and this makes understanding what works difficult. Effectiveness depends on delivery context, and success in one setting does not guarantee the same result in alternate settings. How an intervention works (the underlying mechanisms) in a particular setting for one population group, may not work in the same way for a different group. A realist review provides an iterative theory-driven approach to help understand how and for whom and under what conditions an intervention works.
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Affiliation(s)
- Alice Pearsons
- Edinburgh Napier University, School of Health and Social Care, Sighthill Campus, Sighthill Court, Edinburgh EH11 4BN, UK
| | - Lis Neubeck
- Edinburgh Napier University, School of Health and Social Care, Sighthill Campus, Sighthill Court, Edinburgh EH11 4BN, UK.,Sydney Nursing School, Charles Perkins Centre, University of Sydney, Johns Hopkins Road, Sydney, NSW 2006, Australia
| | - Jeroen M Hendriks
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Port Road, Adelaide SA 5000, Australia.,Flinders University, Caring Futures Institute, College of Nursing and Health Sciences, Sturt Road, Bedford Park, SA 5001, Australia
| | - Coral L Hanson
- Edinburgh Napier University, School of Health and Social Care, Sighthill Campus, Sighthill Court, Edinburgh EH11 4BN, UK
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Group Medical Visits Versus Usual Care for Illness Perception and Hypertension: A Randomized Pilot Study. J Healthc Qual 2023; 45:27-37. [PMID: 35976361 DOI: 10.1097/jhq.0000000000000359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
ABSTRACT Despite separate evidence regarding illness perception (IP) and group medical visits (GMVs) for hypertension, research on both is limited. Here, we have assessed and compared the effectiveness of GMVs and usual care (UC) on IP and blood pressure (BP) in patients with hypertension. This was a two-group parallel randomized controlled study with 1:1 allocation. Patients with essential hypertension on antihypertensive medication and no cognitive impairments were screened for BP control status and eligibility. A web-based program randomly assigned them to the GMV and UC groups. Group medical visits were held once a month for 3 months. Primary and secondary outcome measures included improvements in IP and BP control. Among 152 participants, 40 and 43 were assigned to the GMV and UC groups, respectively. The control group had a 9.3% dropout rate. The chronic timeline and illness coherence improved significantly in the intervention group ( p < .01). Systolic BP in the intervention group decreased significantly compared with that of the control group (Δ: -18.8 ± 18.4 mm Hg vs. Δ: -10.6 ± 12.5 mm Hg, p = .025). The participation in GMVs had a significant association with the odds of an increase in BP regulation (OR 3.8, 95% confidence interval 1.4-10.3, p = .007). Therefore, GMVs may be feasible for BP control in hypertensive patients with similar characteristics.
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16
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Papoutsi C, Hargreaves D, Hagell A, Hounsome N, Skirrow H, Muralidhara K, Colligan G, Ferrey A, Vijayaraghavan S, Greenhalgh T, Finer S. Implementation and delivery of group consultations for young people with diabetes in socioeconomically deprived, ethnically diverse settings. BMC Med 2022; 20:459. [PMID: 36434593 PMCID: PMC9701006 DOI: 10.1186/s12916-022-02654-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 11/07/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Young people with diabetes experience poor clinical and psychosocial outcomes, and consider the health service ill-equipped in meeting their needs. Improvements, including alternative consulting approaches, are required to improve care quality and patient engagement. We examined how group-based, outpatient diabetes consultations might be delivered to support young people (16-25 years old) in socio-economically deprived, ethnically diverse settings. METHODS This multi-method, comparative study recruited a total of 135 young people with diabetes across two implementation and two comparison sites (2017-2019). Informed by a 'researcher-in-residence' approach and complexity theory, we used a combination of methods: (a) 31 qualitative interviews with young people and staff and ethnographic observation in group and individual clinics, (b) quantitative analysis of sociodemographic, clinical, service use, and patient enablement data, and (c) micro-costing analysis. RESULTS Implementation sites delivered 29 group consultations in total. Overall mean attendance per session was low, but a core group of young people attended repeatedly. They reported feeling better understood and supported, gaining new learning from peers and clinicians, and being better prepared to normalise diabetes self-care. Yet, there were also instances where peer comparison proved difficult to manage. Group consultations challenged deeply embedded ways of thinking about care provision and required staff to work flexibly to achieve local tailoring, sustain continuity, and safely manage complex interdependencies with other care processes. Set-up and delivery were time-consuming and required in-depth clinical and relational knowledge of patients. Facilitation by an experienced youth worker was instrumental. There was indication that economic value could derive from preventing at least one unscheduled consultation annually. CONCLUSIONS Group consulting can provide added value when tailored to meet local needs rather than following standardised approaches. This study illustrates the importance of adaptive capability and self-organisation when integrating new models of care, with young people as active partners in shaping service provision. TRIAL REGISTRATION ISRCTN reference 27989430.
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Affiliation(s)
- Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.
| | | | - Ann Hagell
- Association for Young People's Health, London, UK
| | | | - Helen Skirrow
- School of Public Health, Imperial College London, London, UK
| | | | - Grainne Colligan
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Anne Ferrey
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | | | - Trish Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Sarah Finer
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Barts Health NHS Trust, London, UK
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17
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Kingstone T, Chew-Graham CA, Corp N. Interventions to identify and manage depression delivered by 'nontraditional' providers to community-dwelling older adults: A realist review. Health Expect 2022; 25:2658-2679. [PMID: 36068931 DOI: 10.1111/hex.13594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/30/2022] [Accepted: 08/22/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Mental health problems experienced by older adults (60+ years of age) may remain hidden due to individual and system-level barriers. Opportunities to support early identification and management are therefore crucial. The National Health Service recommends wider public services that are embedded within local communities, but are not traditionally part of the healthcare landscape (i.e., 'nontraditional'), could facilitate engagement with healthcare by members of the public. Evidence for interventions involving Fire and Rescue, Police, Library services and postal workers, as nontraditional providers of mental health services, has not been synthesized previously. This review aims to understand how, why and in what contexts mental health interventions delivered by these nontraditional providers, to older adults, work. METHODS A realist review of interventions to identify and/or manage mental health problems (depression with or without anxiety) experienced by older adults. Systematic, cluster and iterative literature searches were conducted. Intervention evidence was appraised for rigour and explanatory relevance and then coded to inform context-mechanism-outcome configurations (CMOCs). A public advisory group supported our initial evidence search strategy and definition of key terms. This review is registered with PROSPERO (CRD42020212498). RESULTS Systematic searches revealed a dearth of evidence reporting mental health interventions delivered by nontraditional providers. Our scope was adjusted to consider interventions delivered by Fire and Police services only and for wider health and wellbeing concerns (e.g., dementia, falls prevention, mental health crises). Forty-three pieces of evidence were synthesized. Key themes included: legitimizing expanded roles, focusing on risk, intervention flexibility and organization integration; further subthemes are described. Themes map onto CMOCs and inform a preliminary programme theory. Findings were transposed to mental health contexts. CONCLUSIONS Findings highlight challenges and opportunities for Fire and Police services, as nontraditional providers, to deliver interventions that identify and/or manage mental health problems among older adults. Our programme theory explains what could work, how, for whom and also by whom (i.e., which public services). Further empirical evidence is needed to test interventions, understand acceptability and inform implementation. PATIENT OR PUBLIC CONTRIBUTION A public advisory group comprising older adults with lived experience of mental health problems and informal caregivers contributed to the original application, reviewed the scope and informed the approach to dissemination.
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Affiliation(s)
- Tom Kingstone
- School of Medicine, Keele University, Staffordshire, UK.,Research and Innovation Department, Midlands Partnership NHS Foundation Trust, Stafford, UK
| | - Carolyn A Chew-Graham
- School of Medicine, Keele University, Staffordshire, UK.,Research and Innovation Department, Midlands Partnership NHS Foundation Trust, Stafford, UK
| | - Nadia Corp
- School of Medicine, Keele University, Staffordshire, UK
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Miller-Rosales C, Lewis VA, Shortell SM, Rodriguez HP. Adoption of Patient Engagement Strategies by Physician Practices in the United States. Med Care 2022; 60:691-699. [PMID: 35833416 PMCID: PMC9378564 DOI: 10.1097/mlr.0000000000001748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patient engagement strategies can equip patients with tools to navigate treatment decisions and improve patient-centered outcomes. Despite increased recognition about the importance of patient engagement, little is known about the extent of physician practice adoption of patient engagement strategies nationally. METHODS We analyzed data collected from the National Survey of Healthcare Organizations and Systems (NSHOS) on physician practice adoption of patient engagement strategies. Stratified-cluster sampling was used to select physician practices operating under different organizational structures. Multivariable linear regression models estimated the association of practice ownership, health information technology functionality, use of screening activities, patient responsiveness, chronic care management processes, and the adoption of patient engagement strategies, including shared decision-making, motivational interviewing, and shared medical appointments. All regression models controlled for participation in payment reforms, practice size, Medicaid revenue percentage, and geographic region. RESULTS We found modest and varied adoption of patient engagement strategies by practices of different ownership types, with health system-owned practices having the lowest adoption of ownership types. Practice capabilities, including chronic care management processes, routine screening of medical and social risks, and patient care dissemination strategies were associated with greater practice-level adoption of patient engagement strategies. CONCLUSIONS This national study is the first to characterize the adoption of patient engagement strategies by US physician practices. We found modest adoption of shared decision-making and motivational interviewing, and low adoption of shared medical appointments. Risk-based payment reform has the potential to motivate greater practice-level patient engagement, but the extent to which it occurs may depend on internal practice capabilities.
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Affiliation(s)
| | - Valerie A Lewis
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Stephen M Shortell
- Division of Health Policy and Management, University of California, Berkeley, School of Public Health, Berkeley, CA
| | - Hector P Rodriguez
- Division of Health Policy and Management, University of California, Berkeley, School of Public Health, Berkeley, CA
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19
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The Economic Evaluation of Team Clinic-Group Approach to a Care Model of Early Adolescents With Type 1 Diabetes. J Pediatr Health Care 2022; 36:430-437. [PMID: 35831218 PMCID: PMC10141521 DOI: 10.1016/j.pedhc.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Glycemic control is challenging for adolescents with type 1 diabetes (T1D). Team Clinic, a shared medical appointment model, has improved psychosocial outcomes in middle school patients with T1D. We aimed to evaluate the costs of delivering Team Clinic. METHOD Participants were randomized into Team Clinic (n = 44) or usual care (n = 42) groups. RESULTS We found no significant difference in 6-month total costs per subject ($3,204 [intervention] vs. $3,476 [control]. No significant differences were found in health care use, test strip use, or continuous glucose monitoring and/or pump. The intervention had more clinic visits (2.41 vs. 1.52 times) and a longer length of visit (2.34 vs. 0.74 hr, but no difference in provider time per patient per visit (median, 0.67 vs. 0.68 hr). DISCUSSION The Team Clinic care model may help young adolescents with T1D improve psychosocial outcomes and increase completion of clinical visits without increasing costs.
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Sumpter IJ, Phillips SM, Magwood GS. Approaches to reducing fragmented care in systemic lupus erythematosus (SLE) and other multimorbid conditions: A realist review. INTERNATIONAL JOURNAL OF CARE COORDINATION 2022. [DOI: 10.1177/20534345221121068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Fragmented care overwhelmingly affects populations with multimorbid chronic conditions, like systemic lupus erythematosus (SLE). However, strategies to mitigate care fragmentation typically focus on singular disease frameworks with insufficient evidence regarding approaches for individuals with two or more concurrent chronic conditions (multimorbidity). This review explores the literature to identify the (C)ontextual influences, underlying (M)echanisms, and associated (O)utcomes of fragmented care prevention in SLE and other multimorbid conditions. Methods A realist review was applied to systematically examine literature, including the search of >1300 published articles focused on SLE and multimorbidity, continuity of care, and approaches to mitigate fragmented care. The analysis was guided by care continuity elements and organized by fragmented care concepts explicated by the MacColl Institute for Healthcare Innovations Care Coordination Model and further grouped for context–mechanism–outcome (CMO) configurations. Results Fourteen articles met inclusion/exclusion criteria and were included in the sample to illustrate the relationship between C-M-O for approaches focused on fragmented care prevention. Favorable outcomes in mechanisms that produced positive responses to resources relevant to fragmented care prevention included 1) opportunities for exposure and negotiation within professional teams, 2) structured health education, role clarity, and access to adherence services for patients, and 3) awareness of workflow waste and use of clinical algorithms. Discussion Review findings suggest using a multidimensional approach to mitigate fragmented care in SLE and other multimorbid conditions. Multidimensional approaches should focus on shared decision-making, social support, social–cultural–economic factors, patient engagement, and technological infrastructure to support the complex care needs of the multimorbid patient.
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Affiliation(s)
- IJ Sumpter
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - SM Phillips
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - GS Magwood
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
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National Implementation of a Group-Based Program Promoting Patient Engagement and Peer Support in the Veterans Health Administration: A Multi-Methods Evaluation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148333. [PMID: 35886181 PMCID: PMC9321656 DOI: 10.3390/ijerph19148333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 12/10/2022]
Abstract
Evidence-based approaches promoting patient engagement and chronic illness self-management include peer support, shared decision-making, and education. Designed based on these components, Taking Charge of My Life and Health (TCMLH) is a group-based, ‘Whole Person’ care program promoting mental and physical self-care and patient empowerment. Despite evidence of effectiveness, little is known about implementation for TCMLH and similar programs. In this first-of-its-kind, multi-methods evaluation conducted between 2015–2020, we report on implementation strategies and intervention adaptations with a contextual analysis to describe TCMLH translational efforts in Veterans Health Administration (VHA) facilities across the United States. Quantitative and qualitative data were collected via listening sessions with TCMLH facilitators, open-ended survey responses from facilitators, and quarterly reports from clinical implementation sites. We used the Consolidated Framework for Implementation Research (CFIR) to analyze, interpret, and organize qualitative findings, and descriptive statistics to analyze quantitative data. Most TCMLH programs (58%) were adapted from the original format, including changes to the modality, duration, or frequency of sessions. Findings suggest these adaptations occurred in response to barriers including space, staffing constraints, and participant recruitment. Overall, findings highlight practical insights for improving the implementation of TCMLH, including recommendations for additional adaptations and tailored implementation strategies to promote its reach.
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Wei J, Lei L, Shieh A, Gupta D, Ahern S, Shen N. Program for Reducing Obesity (PRO): An institutional review of an insurance-based weight loss program utilizing shared medical appointments. Obes Sci Pract 2022; 8:272-278. [PMID: 35664242 PMCID: PMC9159562 DOI: 10.1002/osp4.564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 11/06/2022] Open
Abstract
Background Based on CDC estimates in the United States, the prevalence of obesity was 42.4% in 2017-2018, and the annual cost of obesity was $147 billion in 2008. Yet studies estimate that only 20-40% of adults with obesity received counseling from their primary care providers. Recent studies using shared medical appointments (SMA), where patients are seen by a multidisciplinary team, have shown promising results in obesity management. We developed an insurance-based weight loss program incorporating SMA, called the Program for Reducing Obesity (PRO), and report our findings here. Methods Enrollment began in January 2019 at the UCLA Health Thousand Oaks clinic. Patients age ≥18 years with BMI ≥30 kg/m2 were eligible by referral to PRO, a program consisting of individual visits and SMAs with an obesity medicine board certified endocrinologist and registered dietitian. Primary outcomes were change in weight after 3, 6, and 12 months. Secondary outcomes included proportion that achieved ≥5% weight loss, change in percent body fat, HbA1c, HDL, triglycerides, and blood pressure. Results 102 patients (mean age 59.7 years, 72% women, mean weight 103.6 kg, mean BMI 36.6 kg/m2) have been analyzed, with 91 patients completing at least 12 months of the program. Patients achieved significant weight loss: 3.0%, 5.0%, and 7.8% of their baseline weight after 3, 6, and 12 months respectively. 52% of patients lost ≥5% of their baseline weight after 12 months. Patients had significant reductions in body fat: 2.1%, 7.4%, and 6.7% of their baseline (all p ≤ 0.01) after 3, 6, and 12 months respectively. Improvements were also seen in HbA1c (p ≤ 0.01), triglycerides (p ≤ 0.04), and systolic blood pressure (p ≤ 0.07) after 12 months although not all results achieved statistical significance. Conclusion Our institutional review of PRO, an insurance-based obesity program utilizing SMA, demonstrates a successful approach to promoting weight loss in a community-based setting.
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Affiliation(s)
- Jeffrey Wei
- Department of MedicineDivision of EndocrinologyDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Lei Lei
- Department of MedicineDivision of EndocrinologyDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Albert Shieh
- Division of GeriatricsDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Deepashree Gupta
- Department of MedicineDivision of EndocrinologyDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Susan Ahern
- Department of MedicineDivision of EndocrinologyDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Na Shen
- Department of MedicineDivision of EndocrinologyDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
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Mahajan UV, Sharma N, Maynard M, Kang L, Labak CM, Raghavan A, Sajatovic M, Hoffer A, Shammassian BH, Wright JM, Zhou X, Wright CH. Inpatient virtual shared medical appointments to improve health literacy, increase patient self-efficacy, and reduce provider burnout in acute cerebrovascular pathology patients and their caregivers: a pilot study. Neurosurg Focus 2022; 52:E12. [DOI: 10.3171/2022.4.focus21764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/04/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Admission to the hospital for an acute cerebrovascular condition such as stroke or brain hemorrhage can be a traumatic and disorienting experience for patients and their family members. The COVID-19 pandemic has further intensified this experience in addition to exacerbating clinician and resident burnout. To ameliorate some of these concerns, a team of resident and medical student trainees implemented a virtual shared medical appointment (vSMA) program for inpatients with acute cerebrovascular disorders and their caregivers. The authors hypothesized that an early intervention in the form of a vSMA improves patient and caregiver health literacy and preparedness while simultaneously educating clinical trainees on effective communication skills and reducing clinician burnout.
METHODS
Patients and caregivers of admitted patients were identified through a census of neurosurgery, neurocritical care, and neurology electronic medical records. A weekly 60-minute secure virtual session consisted of introductions and a 10-minute standardized presentation on cerebrovascular disease management, followed by participant-guided discussion. Participants completed presession and postsession surveys. Through this small feasibility study data were obtained regarding present challenges, both expected and unforeseen.
RESULTS
A total of 170 patients were screened, and 13 patients and 26 caregivers participated in at least 1 vSMA session. A total of 6 different healthcare providers facilitated sessions. The vSMA program received overwhelmingly positive feedback from caregivers. Survey responses demonstrated that 96.4% of caregivers and 75% of patients were satisfied with the session, 96.4% of caregivers and 87.5% of patients would recommend this type of appointment to a friend or family member, and 88.8% of providers reported feeling validated by conducting the session. The participant group had a 20% greater percentage of patients discharged home without home needs compared to the nonparticipant group. The primary obstacles encountered included technological frustrations with the consent process and the sessions themselves.
CONCLUSIONS
Implementation of a vSMA program at a tertiary care center during a pandemic was feasible. Themes caregivers expressed on the postsession survey included better understanding of caring for a stroke patient and coping with the unpredictability of a patient’s prognosis. The pandemic has precipitated shifts toward telehealth, but this study highlights the importance of avoiding marginalization of elderly and less technologically inclined populations.
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Affiliation(s)
- Uma V. Mahajan
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Neha Sharma
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Marquis Maynard
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Lei Kang
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Collin M. Labak
- Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Neurosurgery and
| | - Alankrita Raghavan
- Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Neurosurgery and
| | - Martha Sajatovic
- Neurological & Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Alan Hoffer
- Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Neurosurgery and
| | - Berje H. Shammassian
- Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Neurosurgery and
- Department of Neurology, Division of Neurocritical Care, University of Miami Miller School of Medicine, Miami, Florida; and
| | - James M. Wright
- Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Neurosurgery and
- Department of Neurosurgery, Oregon Health & Science University, Portland, Oregon
| | - Xiaofei Zhou
- Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Neurosurgery and
| | - Christina Huang Wright
- Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Neurosurgery and
- Department of Neurosurgery, Oregon Health & Science University, Portland, Oregon
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Implementing video group consultations in general practice during COVID-19: a qualitative study. Br J Gen Pract 2022; 72:e483-e491. [PMID: 35636969 PMCID: PMC9256071 DOI: 10.3399/bjgp.2021.0673] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/10/2022] [Indexed: 01/23/2023] Open
Abstract
Background Group consultations have been gaining ground as a novel approach to service delivery. When in-person care was restricted owing to COVID-19, general practice staff began delivering group consultations remotely over video. Aim To examine how multiple interacting influences underpinned implementation and delivery of video group consultations (VGCs). Design and setting Qualitative study in general practice in England. Method a) 32 semi-structured interviews with patients, clinical, and non-clinical staff (from eight GP surgeries in total), NHS policymakers and programme managers, and other stakeholders; b) observation in relevant training and operational meetings; and c) three co-design workshops (21 participants). Thematic analysis was informed by the Planning and Evaluating Remote Consulting Services (PERCS) framework. Results In the first year of the pandemic, VGCs focused on supporting those with long-term conditions or other shared health and social needs. Most patients welcomed clinical and peer input, and the opportunity to access their practice remotely during lockdown. However, not everyone agreed to engage in group-based care or was able to access IT equipment. At practice level, significant work was needed to deliver VGCs, such as setting up the digital infrastructure, gaining team buy-in, developing new patient-facing online facilitation roles, managing background operational processes, protecting online confidentiality, and ensuring professional indemnity cover. Training provided nationally was seen as instrumental in capacity building for VGC implementation. Conclusion Small scale VGC implementation addressed unmet need during the pandemic. However, embedding VGCs in routine care requires rethinking of operational, infrastructural, and clinical processes. Additional research on costs and benefits at service and patient level is needed.
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Mathisen C, Heyn LG, Jacobsen TI, Bjørk IT, Hansen EH. The use of practice education facilitators to strengthen the clinical learning environment for nursing students: A realist review. Int J Nurs Stud 2022; 134:104258. [DOI: 10.1016/j.ijnurstu.2022.104258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 04/08/2022] [Accepted: 04/09/2022] [Indexed: 11/17/2022]
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Bharmal N, Beidelschies M, Alejandro-Rodriguez M, Alejandro K, Guo N, Jones T, Bradley E. A nutrition and lifestyle-focused shared medical appointment in a resource-challenged community setting: a mixed-methods study. BMC Public Health 2022; 22:447. [PMID: 35255887 PMCID: PMC8900391 DOI: 10.1186/s12889-022-12833-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In order to address disparities in preventable chronic diseases, we adapted a nutrition and lifestyle-focused shared medical appointment (SMA) program to be delivered in an underserved community setting. The objective was to evaluate a community-based nutrition and lifestyle-focused SMA as it relates to acceptability and health and behavior-related outcomes. METHODS A mixed-methods study was performed to evaluate pre-post changes in wellness indices, biometrics, self-efficacy, and trust in medical researchers as part of a community-based SMA. To understand program acceptability including barriers and facilitators for implementation and scalability, we conducted two participant focus groups and five stakeholder interviews and used content analysis to determine major themes. RESULTS Fifteen participants attended 10 weekly sessions. The majority were older adult, African American women. There were pre-post improvements in mean [SD] systolic (-10.5 [7.7] mmHg, p = 0.0001) and diastolic (-4.7 [6.7] mmHg, p = 0.17) blood pressures and weight (-5.7 [6.3] pounds, p = 0.003) at 3 months though these were not significant at 6 months. More individuals reported improvements in health status, daily fruit and vegetable intake, and sleep than at baseline. There were no significant pre-post changes in other wellness indices, self-efficacy, trust in medical researchers, hemoglobin A1c, insulin, or LDL cholesterol. Participants discussed positive health changes as a result of the SMA program, program preferences, and facilitators and barriers to continuing program recommendations in focus groups. SMA implementation was facilitated by clinical staff who adjusted content to a low health literacy group and partnership with a trusted community partner. Sustainability barriers include heavy personnel time and in-kind resources to deliver the program. CONCLUSIONS Nutrition and lifestyle-focused SMAs in a resource-challenged community setting may be an acceptable intervention for underserved patients.
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Affiliation(s)
- Nazleen Bharmal
- Community Health & Partnerships, Cleveland Clinic Community Care, Cleveland Clinic, Ohio, Cleveland, USA.
| | | | | | - Kayla Alejandro
- Center for Functional Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ning Guo
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Tawny Jones
- Center for Functional Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Elizabeth Bradley
- Center for Functional Medicine, Cleveland Clinic, Cleveland, Ohio, USA
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Akyar S, Nyaku A, Lao K, Ruthberg S, Zerbo EA. Satisfaction with group-based appointments among patients with opioid use disorder in an urban buprenorphine clinic. Subst Abus 2022; 43:913-916. [DOI: 10.1080/08897077.2021.2010258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Serra Akyar
- Department of Psychiatry and Behavioral Health Sciences, Northwell Health at Staten Island University Hospital, Staten Island, New York, USA
| | - Amesika Nyaku
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Kristyn Lao
- Department of Psychiatry, NYU Grossman School of Medicine, New York, New York, USA
| | - Stephanie Ruthberg
- Department of Psychiatry, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Erin A. Zerbo
- Department of Psychiatry, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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28
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Grewal US, Brown T, Mudigonda GR, Davila-Chapa C, Thotamgari SR, Crooms C, Singh JS, Mahadevan R. Using Shared Medical Appointments for Delivering Patient-Centered Care to Cancer Survivors: A Feist-Weiller Cancer Center Pilot Study. J Patient Exp 2022; 9:23743735211069834. [PMID: 35071749 PMCID: PMC8772348 DOI: 10.1177/23743735211069834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Shared medical appointments (SMAs) have shown promise in the care of patients with conditions such as diabetes; however, the impact of lifestyle medicine-based SMAs on the overall health status of cancer survivors remains poorly understood. Materials and Methods: This cross-sectional survey of patients was conducted to study the impact of a unique lifestyle medicine-based survivorship program on cancer survivors. Results: A total of 64 patients were telephonically contacted for the survey, out of which 39 (60.9%) patients responded. All patients (39 of 39, 100%) found the program to be helpful in some way; 26 patients (66.7%) found SMAs to be significantly helpful, while 13 patients (33.3%) found SMAs as only somewhat helpful. The majority noted feeling a great sense of support (35 of 39, 89.7%), followed by improvement in appetite (21 of 39, 54%) and improvement in pain (14 of 39, 35.9%). All patients reported at least some improvement in subjective well-being (SWB); patients who attended >3 appointments reported significant/very significant improvement in SWB (P = .03). Conclusion: SMAs offer promise in the effective delivery of lifestyle medicine-focused care to cancer survivors. Further prospective studies are needed to validate these findings.
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Affiliation(s)
- Udhayvir S Grewal
- Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Tyiesha Brown
- Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Ghanshyam R Mudigonda
- Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Cesar Davila-Chapa
- Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Sahith R Thotamgari
- Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Carol Crooms
- Feist-Weiller Cancer Center, Shreveport, LA, USA
| | - Jennifer S Singh
- Feist-Weiller Cancer Center, Shreveport, LA, USA
- Department of Hematology and Oncology, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Rupa Mahadevan
- Feist-Weiller Cancer Center, Shreveport, LA, USA
- Department of Hematology and Oncology, Louisiana State University Health Sciences Center, Shreveport, LA, USA
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29
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Marton J, Smith JC, Heberlein EC, Laboy A, Britt J, Crockett AH. Group Prenatal Care and Emergency Room Utilization. Med Care Res Rev 2021; 79:687-700. [PMID: 34881657 DOI: 10.1177/10775587211059938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Pregnancy-related complaints are a significant driver of emergency room (ER) utilization among women. Because of additional time for patient education and provider relationships, group prenatal care may reduce ER visits among pregnant women by helping them identify appropriate care settings, improving understanding of common pregnancy discomforts, and reducing risky health behaviors. We conducted a retrospective cohort study, utilizing Medicaid claims and birth certificate data from a statewide expansion of group care, to compare ER utilization between pregnant women participating in group prenatal care and individual prenatal care. Using propensity score matching methods, we found that group care was associated with a significant reduction in the likelihood of having any ER utilization (-5.9% among women receiving any group care and -6.0% among women attending at least five group care sessions). These findings suggest that group care may reduce ER utilization among pregnant women and encourage appropriate health care utilization during pregnancy.
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Affiliation(s)
| | | | | | - Ana Laboy
- Georgia State University, Atlanta, GA, USA
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30
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Wile KA, Roy S, Stuckey H, Zimmerman E, Bailey D, Parascando JA, Reedy-Cooper A. Qualitative Needs Assessment for the Development of Chronic Pain Group Medical Visits. J Patient Exp 2021; 8:23743735211063122. [PMID: 34869851 PMCID: PMC8640981 DOI: 10.1177/23743735211063122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Group medical visits (GMVs) for patients with chronic pain are becoming more accessible and have been shown to be successful in furthering patient education on multidisciplinary, nonopioid interventions. Unfortunately, evidence suggests that many group visit models lack sustainability due to recruitment issues and retention rates. Additionally, most of the studies surrounding GMVs are located in primarily urban health centers, potentially limiting their generalizability. This study aims to identify patient interest in and barriers to GMVs for chronic pain and to explore how chronic pain impacts daily lives for GMV content optimization in a nonurban population. Nineteen participants age 18 to 65 years participated in semistructured phone interviews to generate a thematic analysis. Participants received their care from family practitioners at a suburban multiclinic academic medical group and were being prescribed at least 50 morphine milligram equivalents (MME) at the time of recruitment. Analysis generated two themes: (1) Participants expressed specific interest in GMVs with few barriers identified, and (2) Pain has a negative impact on mental health and most aspects daily life, creating a foundation for discussion in GMVs. Findings support significant patient interest in group medical visits for chronic pain, but careful planning is necessary to address patient needs, expectations, and barriers in order to ensure GMV sustainability.
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Affiliation(s)
- Kevin A Wile
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Siddhartha Roy
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Heather Stuckey
- Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
| | | | - David Bailey
- Penn State College of Medicine, Hershey, PA, USA
| | - Jessica A Parascando
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Alexis Reedy-Cooper
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
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Group Medical Care: A Systematic Review of Health Service Performance. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312726. [PMID: 34886452 PMCID: PMC8657170 DOI: 10.3390/ijerph182312726] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/30/2021] [Accepted: 11/30/2021] [Indexed: 11/16/2022]
Abstract
Group care models, in which patients with similar health conditions receive medical services in a shared appointment, have increasingly been adopted in a variety of health care settings. Applying the Triple Aim framework, we examined the potential of group medical care to optimize health system performance through improved patient experience, better health outcomes, and the reduced cost of health care. A systematic review of English language articles was conducted using the Cochrane Controlled Trials Register (CENTRAL), MEDLINE/PubMed, Scopus, and Embase. Studies based on data from randomized control trials (RCTs) conducted in the US and analyzed using an intent-to-treat approach to test the effect of group visits versus standard individual care on at least one Triple Aim domain were included. Thirty-one studies met the inclusion criteria. These studies focused on pregnancy (n = 9), diabetes (n = 15), and other chronic health conditions (n = 7). Compared with individual care, group visits have the potential to improve patient experience, health outcomes, and costs for a diversity of health conditions. Although findings varied between studies, no adverse effects were associated with group health care delivery in these randomized controlled trials. Group care models may contribute to quality improvements, better health outcomes, and lower costs for select health conditions.
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32
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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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Davidson EM, Krasuska M, Jenum AK, Gill JMR, Beune E, Stronks K, van Valkengoed IGM, Diaz E, Sheikh A. Developing a realist informed framework for cultural adaptation of lifestyle interventions for the prevention of type 2 diabetes in South Asian populations in Europe. Diabet Med 2021; 38:e14584. [PMID: 33838051 DOI: 10.1111/dme.14584] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 03/14/2021] [Accepted: 04/08/2021] [Indexed: 01/04/2023]
Abstract
AIMS Selected lifestyle interventions proven effective for White-European populations have been culturally adapted for South Asian populations living in Europe, who are at higher risk of type 2 diabetes. However, a limited theoretical basis underpins how cultural adaptations are believed to augment intervention effectiveness. We undertook a realist review to synthesise existing literature on culturally adapted type 2 diabetes prevention interventions, to develop a framework that shows 'how' cultural adaptation works, for 'whom' and in 'what contexts'. METHODS We followed the stepped methodological approach of realist review. Our work concluded a European-wide project (EuroDHYAN), and core studies were identified from the preceding EuroDHYAN reviews. Data were extracted, coded into themes and synthesised to create 'Context-Mechanism-Outcome' configurations and to generate a refined explanatory framework. RESULTS We identified eight core intervention papers. From this evidence, and supporting literature, we examined the 'Team' domain of cultural adaptation and identified a mechanism of shared cultural identity which we theorised as contributing to strong team-participant relationships. We also identified four key contexts which influenced intervention outcomes: 'research setting' and 'heterogeneous populations' (intrinsic to the intervention) and 'broader environment' and 'socio-cultural stress' (extrinsic barriers). CONCLUSIONS This work instigates research into the mechanisms of cultural adaptation which, if pursued, will allow a more nuanced understanding of how to apply adaptations, and for whom. In practice we recommend greater consideration of heterogeneous and intersecting population characteristics; how intervention design can safeguard sustainability; and how the four key contexts identified influence how, and whether, these interventions work.
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Affiliation(s)
| | | | - Anne Karen Jenum
- General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jason M R Gill
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Erik Beune
- Amsterdam UMC, Department of Public and Occupational Health, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Karien Stronks
- Amsterdam UMC, Department of Public and Occupational Health, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Irene G M van Valkengoed
- Amsterdam UMC, Department of Public and Occupational Health, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Esperanza Diaz
- Department for Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK
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34
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Funderburk JS, Gass J, Shepardson RL, Mitzel LD, Buckheit KA. Practical Opportunities for Biopsychosocial Education Through Strategic Interprofessional Experiences in Integrated Primary Care. Front Psychiatry 2021; 12:693729. [PMID: 34603099 PMCID: PMC8481570 DOI: 10.3389/fpsyt.2021.693729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 08/02/2021] [Indexed: 11/13/2022] Open
Abstract
Even with the expansion of primary care teams to include behavioral health and other providers from a range of disciplines, providers are regularly challenged to deliver care that adequately addresses the complex array of biopsychosocial factors underlying the patient's presenting concern. The limits of expertise, the ever-changing shifts in evidence-based practices, and the difficulties of interprofessional teamwork contribute to the challenge. In this article, we discuss the opportunity to leverage the interprofessional team-based care activities within integrated primary care settings as interactive educational opportunities to build competencies in biopsychosocial care among primary care team members. We argue that this approach to learning while providing direct patient care not only facilitates new provider knowledge and skills, but also provides a venue to enhance team processes that are key to delivering integrated biopsychosocial care to patients. We provide three case examples of how to utilize strategic planning within specific team-based care activities common in integrated primary care settings-shared medical appointments, conjoint appointments, and team huddles-to facilitate educational objectives.
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Affiliation(s)
- Jennifer S. Funderburk
- Veterans Affairs Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, United States
- Department of Psychology, Syracuse University, Syracuse, NY, United States
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States
| | - Julie Gass
- Veterans Affairs Center for Integrated Healthcare, Western New York VA Healthcare System, Buffalo, NY, United States
- Department of Psychology, University at Buffalo, State University of New York, Buffalo, NY, United States
| | - Robyn L. Shepardson
- Veterans Affairs Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, United States
- Department of Psychology, Syracuse University, Syracuse, NY, United States
| | - Luke D. Mitzel
- Veterans Affairs Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, United States
| | - Katherine A. Buckheit
- Veterans Affairs Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, United States
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Optimizing Care Delivery by Applying an Innovative Shared Medical Appointment Model for Determination of Cochlear Implant Candidacy. Otol Neurotol 2021; 42:e1008-e1012. [PMID: 33782259 DOI: 10.1097/mao.0000000000003154] [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
OBJECTIVE To develop and implement an innovative group appointment with the potential to improve access to cochlear implantation (CI) while maintaining patient satisfaction and experience. PATIENTS Adult patients with advanced sensorineural hearing loss. INTERVENTIONS Implementation of novel shared medical appointment (SMA) model. MAIN OUTCOME MEASURES Patient satisfaction with group visit; anecdotal description of provider efficiency and experience. RESULTS Survey data were collected from 166 adults who participated in a group CI candidacy appointment from September 2017 to February 2020 as part of a quality improvement initiative. Provider time is anecdotally optimized by accommodating more patients in a shorter timeframe while effectively triaging those candidates most likely to meet candidacy criteria for a full CI evaluation. Most importantly, patient feedback has been positive which suggests that patients find value in this novel format. CONCLUSIONS The current climate of healthcare demands that providers maximize the efficacy and efficiency of patient care. Our large CI program has determined that using an SMA format as an entry point for CI candidacy evaluation offers many benefits. The group appointment improves patient throughput and also provides a positive patient experience. Group visits offer a viable solution for increasing patient access to CI while maintaining quality in a busy academic medical center setting.
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Graham F, Tang MY, Jackson K, Martin H, O'Donnell A, Ogunbayo O, Sniehotta FF, Kaner E. Barriers and facilitators to implementation of shared medical appointments in primary care for the management of long-term conditions: a systematic review and synthesis of qualitative studies. BMJ Open 2021; 11:e046842. [PMID: 34429309 PMCID: PMC8386233 DOI: 10.1136/bmjopen-2020-046842] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To synthesise the published literature on practitioner, patient and carer views and experiences of shared medical appointments (SMAs) for the management of long-term conditions in primary care. DESIGN Systematic review of qualitative primary studies. METHODS A systematic search was conducted using MEDLINE (Ovid), PsycINFO (Ovid), CINAHL (EBSCOhost), Web of Science, Social Science Premium Collection (Proquest) and Scopus (SciVerse) from database starting dates to June 2019. Practitioner, patient and carer perspectives were coded separately. Deductive coding using a framework approach was followed by thematic analysis and narrative synthesis. Quality assessment was conducted using the Critical Appraisal Skills Programme for qualitative studies. RESULTS We identified 18 unique studies that reported practitioner (n=11), patient (n=14) and/or carer perspectivs(n=3). Practitioners reported benefits of SMAs including scope for comprehensive patient-led care, peer support, less repetition and improved efficiency compared with 1:1 care. Barriers included administrative challenges and resistance from patients and colleagues, largely due to uncertainties and unclear expectations. Skilled facilitators, tailoring of SMAs to patient groups, leadership support and teamwork were reported to be important for successful delivery. Patients' reported experiences were largely positive with the SMAs considered a supportive environment in which to share and learn about self-care, though the need for good facilitation was recognised. Reports of carer experience were limited but included improved communication between carer and patient. CONCLUSION There is insufficient evidence to indicate whether views and experiences vary between staff, medical condition and/or patient characteristics. Participant experiences may be subject to reporting bias. Policies and guidance regarding best practice need to be developed with consideration given to resource requirements. Further research is needed to capture views about wider and co-occurring conditions, to hear from those without SMA experience and to understand which groups of patients and practitioners should be brought together in an SMA for best effect. PROSPERO REGISTRATION NUMBER CRD42019141893.
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Affiliation(s)
- Fiona Graham
- NIHR Policy Research Unit in Behavioural Science, Newcastle University, Newcastle upon Tyne, UK
| | - Mei Yee Tang
- NIHR Policy Research Unit in Behavioural Science, Newcastle University, Newcastle upon Tyne, UK
| | | | - Helen Martin
- Research and Evidence Team, NECS, Newcastle upon Tyne, UK
| | - Amy O'Donnell
- NIHR Policy Research Unit in Behavioural Science, Newcastle University, Newcastle upon Tyne, UK
| | - Oladapo Ogunbayo
- Population Health Science Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Falko F Sniehotta
- NIHR Policy Research Unit in Behavioural Science, Newcastle University, Newcastle upon Tyne, UK
- Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, The Netherlands
| | - Eileen Kaner
- NIHR Policy Research Unit in Behavioural Science, Newcastle University, Newcastle upon Tyne, UK
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Pantalone KM, Smolarz BG, Ramasamy A, Baz Hecht M, Harty BJ, Rogen B, Griebeler ML, Borukh E, Young JB, Burguera B. Effectiveness of Combining Antiobesity Medication With an Employer-Based Weight Management Program for Treatment of Obesity: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2116595. [PMID: 34255049 PMCID: PMC8278271 DOI: 10.1001/jamanetworkopen.2021.16595] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
IMPORTANCE The clinical efficacy of antiobesity medications (AOMs) as adjuncts to lifestyle intervention is well characterized, but data regarding their use in conjunction with workplace wellness plans are lacking, and coverage of AOMs by US private employers is limited. OBJECTIVE To determine the effect of combining AOMs with a comprehensive, interdisciplinary, employer-based weight management program (WMP) compared with the WMP alone on weight loss, treatment adherence, and work productivity and limitations. DESIGN, SETTING, AND PARTICIPANTS This 1-year, single-center, open-label, parallel-group, real-world, randomized clinical trial was conducted at the Cleveland Clinic's Endocrinology and Metabolism Institute in Cleveland, Ohio, from January 7, 2019, to May 22, 2020. Participants were adults with obesity (body mass index [BMI; calculated as weight in kilograms divided by height in meters squared] ≥30) enrolled in the Cleveland Clinic Employee Health Plan. INTERVENTIONS In total, 200 participants were randomized 1:1, 100 participants to WMP combined with an AOM (WMP+Rx), and 100 participants to WMP alone. The WMP was the Cleveland Clinic Endocrinology and Metabolism Institute's employer-based integrated medical WMP implemented through monthly multidisciplinary shared medical appointments. Participants in the WMP+Rx group initiated treatment with 1 of 5 US Food and Drug Administration-approved medications for chronic weight management (orlistat, lorcaserin, phentermine/topiramate, naltrexone/bupropion, and liraglutide, 3.0 mg) according to standard clinical practice. MAIN OUTCOMES AND MEASURES The primary end point was the percentage change in body weight from baseline to month 12. RESULTS The 200 participants were predominately (177 of 200 [88.5%]) women, had a mean (SD) age of 50.0 (10.3) years, and a mean (SD) baseline weight of 105.0 (19.0) kg. For the primary intention-to-treat estimand, the estimated mean (SE) weight loss was -7.7% (0.7%) for the WMP+Rx group vs -4.2% (0.7%) for the WMP group, with an estimated treatment difference of -3.5% (95% CI, -5.5% to -1.5%) (P < .001). The estimated percentage of participants achieving at least 5% weight loss was 62.5% for WMP+Rx vs 44.8% for WMP (P = .02). The rate of attendance at shared medical appointments was higher for the WMP+Rx group than for the WMP group. No meaningful differences in patient-reported work productivity or limitation measures were observed. CONCLUSIONS AND RELEVANCE Clinically meaningful superior mean weight loss was achieved when access to AOMs was provided in the real-world setting of an employer-based WMP, compared with the WMP alone. Such results may inform employer decisions regarding AOM coverage and guide best practices for comprehensive, interdisciplinary employer-based WMPs. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03799198.
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Affiliation(s)
- Kevin M. Pantalone
- Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio
| | | | | | | | | | - Bruce Rogen
- Cleveland Clinic Employee Health Plan, Cleveland, Ohio
| | | | - Elena Borukh
- Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio
| | - James B. Young
- Cleveland Clinic Executive Administration, Cleveland, Ohio
| | - Bartolome Burguera
- Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio
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Symington E, El‐Osta A, Birrell F. Supported self‐care is integral to lifestyle medicine: Can virtual group consultations promote them both? LIFESTYLE MEDICINE 2021. [DOI: 10.1002/lim2.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Emily Symington
- Parchmore Medical Centre Croydon UK
- Population Health Sciences Institute Newcastle University Newcastle upon Tyne UK
| | - Austen El‐Osta
- Self‐Care Academic Research Unit School of Public Health Imperial College London UK
| | - Fraser Birrell
- Population Health Sciences Institute Newcastle University Newcastle upon Tyne UK
- Medical Research Council Versus Arthritis Centre for Integrated Research into Musculoskeletal Ageing Newcastle University Newcastle upon Tyne UK
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Heisler M, Burgess J, Cass J, Chardos JF, Guirguis AB, Strohecker LA, Tremblay AS, Wu WC, Zulman DM. Evaluating the Effectiveness of Diabetes Shared Medical Appointments (SMAs) as Implemented in Five Veterans Affairs Health Systems: a Multi-site Cluster Randomized Pragmatic Trial. J Gen Intern Med 2021; 36:1648-1655. [PMID: 33532956 PMCID: PMC8175536 DOI: 10.1007/s11606-020-06570-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 12/29/2020] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To examine whether diabetes shared medical appointments (SMAs) implemented as part of usual clinical practice in diverse health systems are more effective than usual care in improving and sustaining A1c improvements. RESEARCH DESIGN AND METHODS A multi-site cluster randomized pragmatic trial examining implementation in clinical practice of diabetes SMAs in five Veterans Affairs (VA) health systems was conducted from 2016 to 2020 among 1537 adults with type 2 diabetes and elevated A1cs. Eligible patients were randomly assigned to either: (1) invitation to participate in a series of SMAs totaling 8-9 h; or (2) continuation of usual care. Relative change in A1c (primary outcome) and in systolic blood pressure, insulin starts, statin starts, and anti-hypertensive medication classes (secondary outcomes) were measured as part of usual clinical care at baseline, at 6 months and at 12 months (~7 months after conclusion of the final SMA in four of five sites). We examined outcomes in three samples of SMA participants: all those scheduled for a SMA, those attending at least one SMA, and those attending at least half of SMAs. RESULTS Baseline mean A1c was 9.0%. Participants scheduled for an SMA achieved A1c reductions 0.35% points greater than the control group between baseline and 6-months follow up (p = .001). Those who attended at least one SMA achieved reductions 0.42 % points greater (p < .001), and those who attended at least half of scheduled SMAs achieved reductions 0.53 % points greater (p < .001) than the control group. At 12-month follow-up, the three SMA analysis samples achieved reductions from baseline ranging from 0.16 % points (p = 0.12) to 0.29 % points (p = .06) greater than the control group. CONCLUSIONS Diabetes SMAs as implemented in real-life diverse clinical practices improve glycemic control more than usual care immediately after the SMAs, but relative gains are not maintained. Our findings suggest the need for further study of whether a longer term SMA model or other follow-up strategies would sustain relative clinical improvements associated with this intervention. TRIAL REGISTRATION ClinicalTrials.gov ID NCT02132676.
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Affiliation(s)
- Michele Heisler
- Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
- North Campus Research Complex, University of Michigan, Ann Arbor, MI, USA.
| | - Jennifer Burgess
- Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Jeffrey Cass
- VA Northern California Health Care System, Mather, CA, USA
| | - John F Chardos
- Veterans Affairs Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | | | | | - Adam S Tremblay
- Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Wen-Chih Wu
- Providence VA Medical Center, Providence, RI, USA
| | - Donna M Zulman
- Veterans Affairs Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA
- Division of General Medicine Disciplines, Stanford University, Stanford, CA, USA
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Hendriks MAL, van Wanroij JWM, Laros-van Gorkom BAP, Nijhuis-van der Sanden MWG, Hoogeboom TJ. The SLIM study-Shared medical appointments to change lifestyles of overweight people with haemophilia: A randomized multiple baseline (n-of-1) design. Haemophilia 2021; 27:606-617. [PMID: 33942447 PMCID: PMC8360008 DOI: 10.1111/hae.14306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/22/2021] [Accepted: 03/17/2021] [Indexed: 01/06/2023]
Abstract
INTRODUCTION People with haemophilia suffer from haemophilic joint disease that may result in physical inactivity and overweight. Shared medical appointments (SMAs) might help limit the consequences of haemophilic arthropathy. SMAs are group meetings supervised by one or more healthcare professionals that can be utilized to improve lifestyle. AIM To evaluate the feasibility and efficacy of SMAs in people with haemophilia to improve physical activity and eating habits. METHODS A multiple baseline single-case design was used. Overweight people with haemophilia were eligible to participate. Seven weekly SMAs were conducted using multiple behavioural change techniques to improve physical activity and eating habits. Feasibility of SMAs was evaluated using (a) dropout rate, (b) occurrence of adverse events (AEs), (c) adherence rate and (d) patient satisfaction. During 13 weeks, physical activity was measured daily and eating habits were measured three times per week. The efficacy of SMAs was determined using randomization tests and visual data inspection. RESULTS Out of the six men participating in the study, one participant dropped out. No study-related AEs occurred. The adherence rate of SMAs was 80%, and participants reported to be 'very satisfied' with the SMAs. Randomization tests and visual analyses demonstrated (statistical) improvements in physical activity (p = .03). No effect was found in self-reported eating habits (p = .55). CONCLUSION Shared medical appointments are feasible in people with haemophilia and appear to improve physical activity. The effect on improving eating habits could not be established. Scientific replication of our approach is warranted to confirm or refute the merit of SMAs in people with haemophilia.
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Affiliation(s)
- Marcel A L Hendriks
- Department of Health Innovations and Technology, Research Group Empowering Healthy Behaviour, Fontys University of Applied Sciences, Eindhoven, the Netherlands.,Radboud Institute for Health Sciences, IQ Healthcare, Radboud university medical center, Nijmegen, the Netherlands
| | | | | | | | - Thomas J Hoogeboom
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud university medical center, Nijmegen, the Netherlands
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Vedanthan R, Kamano JH, Chrysanthopoulou SA, Mugo R, Andama B, Bloomfield GS, Chesoli CW, DeLong AK, Edelman D, Finkelstein EA, Horowitz CR, Manyara S, Menya D, Naanyu V, Orango V, Pastakia SD, Valente TW, Hogan JW, Fuster V. Group Medical Visit and Microfinance Intervention for Patients With Diabetes or Hypertension in Kenya. J Am Coll Cardiol 2021; 77:2007-2018. [PMID: 33888251 PMCID: PMC8065205 DOI: 10.1016/j.jacc.2021.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 02/25/2021] [Accepted: 03/01/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Incorporating social determinants of health into care delivery for chronic diseases is a priority. OBJECTIVES The goal of this study was to evaluate the impact of group medical visits and/or microfinance on blood pressure reduction. METHODS The authors conducted a cluster randomized trial with 4 arms and 24 clusters: 1) usual care (UC); 2) usual care plus microfinance (MF); 3) group medical visits (GMVs); and 4) GMV integrated into MF (GMV-MF). The primary outcome was 1-year change in systolic blood pressure (SBP). Mixed-effects intention-to-treat models were used to evaluate the outcomes. RESULTS A total of 2,890 individuals (69.9% women) were enrolled (708 UC, 709 MF, 740 GMV, and 733 GMV-MF). Average baseline SBP was 157.5 mm Hg. Mean SBP declined -11.4, -14.8, -14.7, and -16.4 mm Hg in UC, MF, GMV, and GMV-MF, respectively. Adjusted estimates and multiplicity-adjusted 98.3% confidence intervals showed that, relative to UC, SBP reduction was 3.9 mm Hg (-8.5 to 0.7), 3.3 mm Hg (-7.8 to 1.2), and 2.3 mm Hg (-7.0 to 2.4) greater in GMV-MF, GMV, and MF, respectively. GMV and GMV-MF tended to benefit women, and MF and GMV-MF tended to benefit poorer individuals. Active participation in GMV-MF was associated with greater benefit. CONCLUSIONS A strategy combining GMV and MF for individuals with diabetes or hypertension in Kenya led to clinically meaningful SBP reductions associated with cardiovascular benefit. Although the significance threshold was not met in pairwise comparison hypothesis testing, confidence intervals for GMV-MF were consistent with impacts ranging from substantive benefit to neutral effect relative to UC. Incorporating social determinants of health into care delivery for chronic diseases has potential to improve outcomes. (Bridging Income Generation With Group Integrated Care [BIGPIC]; NCT02501746).
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Affiliation(s)
- Rajesh Vedanthan
- New York University Grossman School of Medicine, New York, New York, USA.
| | - Jemima H Kamano
- School of Medicine, Moi University College of Health Sciences, Eldoret, Kenya; Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | | | - Richard Mugo
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Benjamin Andama
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | | | | | | | | | - Eric A Finkelstein
- Duke University, Durham, North Carolina, USA; Duke-National University of Singapore Medical School, Singapore
| | - Carol R Horowitz
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Simon Manyara
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Diana Menya
- School of Public Health, Moi University College of Health Sciences, Eldoret, Kenya
| | - Violet Naanyu
- School of Arts and Social Sciences, Moi University, Eldoret, Kenya
| | - Vitalis Orango
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | | | | | | | - Valentin Fuster
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Beidelschies M, Alejandro-Rodriguez M, Guo N, Postan A, Jones T, Bradley E, Hyman M, Rothberg MB. Patient outcomes and costs associated with functional medicine-based care in a shared versus individual setting for patients with chronic conditions: a retrospective cohort study. BMJ Open 2021; 11:e048294. [PMID: 33849860 PMCID: PMC8051390 DOI: 10.1136/bmjopen-2020-048294] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To compare outcomes and costs associated with functional medicine-based care delivered in a shared medical appointment (SMA) to those delivered through individual appointments. DESIGN A retrospective cohort study was performed to assess outcomes and cost to deliver care to patients in SMAs and compared with Propensity Score (PS)-matched patients in individual appointments. SETTING A single-centre study performed at Cleveland Clinic Center for Functional Medicine. PARTICIPANTS A total of 9778 patients were assessed for eligibility and 7323 excluded. The sample included 2455 patients (226 SMAs and 2229 individual appointments) aged ≥18 years who participated in in-person SMAs or individual appointments between 1 March 2017 and 31 December 2019. Patients had a baseline Patient-Reported Outcome Measurement Information System (PROMIS) Global Physical Health (GPH) score and follow-up score at 3 months. Patients were PS-matched 1:1 with 213 per group based on age, sex, race, marital status, income, weight, body mass index, blood pressure (BP), PROMIS score and functional medicine diagnostic category. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was change in PROMIS GPH at 3 months. Secondary outcomes included change in PROMIS Global Mental Health (GMH), biometrics, and cost. RESULTS Among 213 PS-matched pairs, patients in SMAs exhibited greater improvements at 3 months in PROMIS GPH T-scores (mean difference 1.18 (95% CI 0.14 to 2.22), p=0.03) and PROMIS GMH T-scores (mean difference 1.78 (95% CI 0.66 to 2.89), p=0.002) than patients in individual appointments. SMA patients also experienced greater weight loss (kg) than patients in individual appointments (mean difference -1.4 (95% CI -2.15 to -0.64), p<0.001). Both groups experienced a 5.5 mm Hg improvement in systolic BP. SMAs were also less costly to deliver than individual appointments. CONCLUSION SMAs deliver functional medicine-based care that improves outcomes more than care delivered in individual appointments and is less costly to deliver.
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Affiliation(s)
| | | | - Ning Guo
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Anna Postan
- Community Care, Cleveland Clinic, Cleveland, Ohio, USA
| | - Tawny Jones
- Center for Functional Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Elizabeth Bradley
- Center for Functional Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mark Hyman
- Center for Functional Medicine, Cleveland Clinic, Cleveland, Ohio, USA
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Tam EK, De Arrigunaga S, Shah M, Kefella H, Soriano S, Rowe S. Patient and Clinician Satisfaction With Shared Medical Appointments for Glaucoma. Semin Ophthalmol 2021; 37:17-22. [PMID: 33720810 DOI: 10.1080/08820538.2021.1896758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Shared Medical Appointments (SMAs) are patient-centered care tools designed to administer patient counseling and education, typically delivered individually, in a group setting. SMAs are effective in facilitating peer-learning, resulting in improvement in knowledge and health behavior. This study aimed to implement what we know of as the first ophthalmology SMA done in the United States. We evaluated the implementation feasibility, patient and provider experience, changes in patient knowledge, and provider stress. Five glaucoma patients who expressed issues with adherence during their clinic visit at Boston Medical Center (BMC) who were interested in the SMA were recruited. Patients and staff had a positive experience with the SMA. There was a marked increase in patient glaucoma knowledge and a decrease in average staff member stress level score during the SMA. From all standpoints, including billing and management, we conclude that SMA implementation is feasible in ophthalmology departments in academic settings.
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Affiliation(s)
- Emily K Tam
- Department of Ophthalmology, Boston University Medical Center, Boston, USA
| | - Sofia De Arrigunaga
- Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Madhura Shah
- Boston University School of Medicine, Boston, USA
| | - Haben Kefella
- Department of Ophthalmology, Boston University Medical Center, Boston, USA
| | - Scarlet Soriano
- Department of Family Medicine, Boston University Medical Center, Boston, USA
| | - Susannah Rowe
- Department of Ophthalmology, Boston University Medical Center, Boston, USA
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Experience of implementing and delivering group consultations in UK general practice: a qualitative study. Br J Gen Pract 2021; 71:e413-e422. [PMID: 33685921 PMCID: PMC8049217 DOI: 10.3399/bjgp.2020.0856] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/08/2021] [Indexed: 11/04/2022] Open
Abstract
Background Group consultations are a relatively new concept in UK primary care and are a suggested solution to current workload pressures in general practice. Little is known about the experience of implementing and delivering this approach from staff and organisational perspectives. Aim To explore the experience of implementing and delivering group consultations in general practice. Design and setting Qualitative telephone interview study. Method Topic guides explored the perspectives and experiences of general practice staff on the implementation and delivery of group consultations. Data analysis adopted principles of the Framework Method underpinned by Normalisation Process Theory. Results Interviews were conducted with 8 GPs, 8 practice nurses, 1 nurse associate, 1 practice pharmacist, 1 deputy practice manager, and 1 healthcare assistant. Four themes were identified: sense making of group consultations; the work associated with initiating group consultations; the experiences of operationalising group consultations; and sustaining change. Group consultations made sense to participants as a mechanism to reduce burden on primary care, enhance multidisciplinary working, and provide patient-centred care. Implementation required strong leadership from a ‘champion’, and a facilitator had a pivotal role in operationalising the approach. The associated workload was often underestimated. Barriers to embedding change included achieving whole practice buy-in, competing practice priorities, and system-level flexibility. Conclusion General practice clinicians enjoyed group consultations, yet significant work is required to initiate and sustain the approach. An implementation plan considering leadership, roles and responsibilities, and wider organisational support is required at the outset. Further research or evaluation is needed to measure process outcomes.
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Feasibility of Four Interventions to Improve Treatment Adherence in Migrants Living with HIV in The Netherlands. Diagnostics (Basel) 2020; 10:diagnostics10110980. [PMID: 33233835 PMCID: PMC7699853 DOI: 10.3390/diagnostics10110980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 11/17/2022] Open
Abstract
We evaluated the feasibility and efficacy of four existing interventions to improve adherence to them in migrants living with HIV (MLWH): directly administered antiretroviral therapy (DAART), group medical appointments (GMA), early detection and treatment of psychological distress, and peer support by trained MLWH. At baseline and after the interventions, socio-demographic characteristics, psychosocial variables, and data on HIV treatment adherence were collected. The two questionnaires were completed by 234/301 (78%) MLWH included at baseline. Detectable HIV RNA decreased (from 10.3 to 6.8%) as did internalized HIV-related stigma (from 15 to 14 points), and self-reported adherence increased (between 5.5 and 8.3%). DAART and GMA were not feasible interventions. Screening of psychological distress was feasible; however, follow-up diagnostic screening and linkage to psychiatric services were not. Peer support for and by MLWH was feasible. Within this small intervention group, results on HIV RNA < 400 copies/mL (decrease of 23.6%) and outpatient clinic attendance (up to 20.4% kept more appointments) were promising.
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Pool J, Akhlaghpour S, Fatehi F. Towards a contextual theory of Mobile Health Data Protection (MHDP): A realist perspective. Int J Med Inform 2020; 141:104229. [DOI: 10.1016/j.ijmedinf.2020.104229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/09/2020] [Accepted: 07/03/2020] [Indexed: 12/19/2022]
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Tsiamparlis-Wildeboer AHC, Feijen-De Jong EI, Scheele F. Factors influencing patient education in shared medical appointments: Integrative literature review. PATIENT EDUCATION AND COUNSELING 2020; 103:1667-1676. [PMID: 32376140 DOI: 10.1016/j.pec.2020.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 02/28/2020] [Accepted: 03/06/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE This integrative literature review investigates the factors influencing patient education in Shared Medical Appointments. METHODS Following template analysis method, we used key concepts of the Social Cognitive Theory (SCT) and Social Constructivism as a priori themes. After detailed analysis of the included studies, we deduced subthemes, forming a final template. Based on this final template, we analysed our data again as a final check. RESULTS We included 22 studies. We found that the factors feeling of bonding, humour, feeling of safety, access to information, time, relationship participants-staff, modelling and self-regulation influence the education of SMA participants. Furthermore, we found that health care providers function both as leaders and peers. CONCLUSION We found eight factors that influence the education of SMA participants. Health care providers exert influence on these factors, but in turn, they are also influenced by them in their transfer of knowledge. PRACTICE IMPLICATIONS In order to create a climate of learning and to promote transfer of knowledge, these eight factors should be considered. Health care providers should be aware of their roles and they might need some extra skills for their leadership roles. This can also lead to practical implications for the curriculum in medical schools.
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Affiliation(s)
- Anna H C Tsiamparlis-Wildeboer
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Midwifery Science, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Medicine, Groningen, The Netherlands; AVAG (Academy Midwifery Amsterdam and Groningen), Groningen, The Netherlands.
| | - Esther I Feijen-De Jong
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Midwifery Science, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Medicine, Groningen, The Netherlands; AVAG (Academy Midwifery Amsterdam and Groningen), Groningen, The Netherlands
| | - Fedde Scheele
- Vrije Universiteit Amsterdam, Athena Institute for Transdisciplinary Research, Amsterdam, The Netherlands; Amsterdam UMC, The Netherlands
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Team clinic: Expansion of a multidisciplinary care model for adolescents with type 1 diabetes. Contemp Clin Trials 2020; 95:106079. [PMID: 32634486 DOI: 10.1016/j.cct.2020.106079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/24/2020] [Accepted: 06/29/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Adolescent and young adults (AYA) with Type 1 Diabetes (T1D) experience more difficulty with glycemic control than patients in all other age groups. The shared medical appointment (SMA) model has been effective in multiple healthcare populations, but the feasibility and effectiveness of SMA in AYA patients with T1D is unclear. METHODS This research leverages the team's multidisciplinary expertise to develop an engaging intervention toolkit and test the implementation of the Team Clinic care model for the treatment of T1D among middle school adolescents in a large urban children's hospital serving an economically, racially and ethnically diverse population. In Phase 1, the team will manualize the Team Clinic care model into an engaging, age-appropriate educational and intervention toolkit. In Phase 2, the team will conduct a randomized clinical trial to test the feasibility and usability of the toolkit from the provider perspective (team member satisfaction; clinical efficiency; compliance with American Diabetes Association, American Association of Diabetes Educators, and California Children's Services standards; and payor-level cost data) and the preliminary efficacy of the intervention toolkit on patient- and family-level outcomes (attendance, acceptability/satisfaction with care, patient-level cost data, diabetes outcomes, diabetes family conflict, diabetes distress, and depression). DISCUSSION AYA patients with T1D often receive care in clinics and institutions with limited resources and time. This research tests the feasibility and efficacy of an innovative and potentially cost-effective SMA model to address the unique needs of underserved populations, while meeting national and state clinical standards. Trial registration The study is registered with ClinicalTrials.gov (Protocol Record: NCT04190368).
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Novak KL, Halasz J, Andrews C, Johnston C, Schoombee W, Tanyingoh D, Kaplan GG, van Zanten SV, Swain M. Nurse-Led, Shared Medical Appointments for Common Gastrointestinal Conditions-Improving Outcomes Through Collaboration With Primary Care in the Medical Home: A Prospective Observational Study. J Can Assoc Gastroenterol 2020; 3:59-66. [PMID: 32328544 PMCID: PMC7165260 DOI: 10.1093/jcag/gwy061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 10/19/2018] [Indexed: 12/16/2022] Open
Abstract
Background Gastroesophageal reflux disease (GERD), dyspepsia and irritable bowel syndrome (IBS) are common gastrointestinal disorders accounting for a significant demand for specialty care. The aim of this study was to evaluate safety, access and outcomes of patients assessed by a nurse-led, shared medical appointment. Methods This prospective observational study utilized a sample of 770 patients referred to a gastroenterology Central Access and Triage for routine GERD, dyspepsia or IBS from 2011 to 2014. Patient demographics, clinical indication, frequency and outcomes of endoscopy, quality of life, wait times and long-term outcomes (>2 years) were compared between 411 patients assigned to a nurse-led, shared medical appointment and 359 patients assigned to clinic for a gastroenterology physician consultation. Results The nurse-led, shared medical appointment pathway compared with usual care pathway had shorter median wait times (12.6 weeks versus 137.1 weeks, P < 0.0001), fewer endoscopic exams (50.9% versus 76.3%, P < 0.0001), less gastroenterology re-referrals (4.6% versus 15.6%, P < 0.0001), and reduced visits to the emergency department (6.1% versus 12.0%, P = 0.004). After two years of follow-up, outcomes were no different between the pathways. Conclusions Patients with GERD, IBS or dyspepsia who attend the nurse-led, shared medical appointment have improved access to care and reduced resource utilization without increased risk of significant gastrointestinal outcomes after two years of follow-up.
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Affiliation(s)
| | - Jennifer Halasz
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - Christopher Andrews
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | | | - Divine Tanyingoh
- Division of Gastroenterology and Hepatology and Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Gilaad G Kaplan
- Division of Gastroenterology and Hepatology and Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | | | - Mark Swain
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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Tataryn A, Derbowka H, Shen X, Gage E, Kang E, Wlock J, Lieffers J. A Qualitative Evaluation of Patient Experiences With Group Medical and Individual Education Appointments for Type 2 Diabetes Management in Saskatchewan, Canada. DIABETES EDUCATOR 2020; 46:261-270. [PMID: 32228289 DOI: 10.1177/0145721720913278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to capture information on patient experiences and perspectives of group medical appointments (GMAs) and compare them to those attending individual appointments (IAs) with the diabetes education team (usual care) for managing type 2 diabetes. METHODS Adults (N = 18; 61% male; 83% 50-70 years old ) with type 2 diabetes (or prediabetes) living in rural Saskatchewan were recruited to complete a semistructured interview on their experiences with GMAs or IAs. To be eligible to participate, individuals must have attended at least 2 GMAs or 2 IAs. Transcripts were coded and analyzed using content analysis. RESULTS Overall, participants spoke highly of their respective appointment type. Results indicated that both appointment types positively influenced understanding of diabetes management, with the most notable difference being greater understanding of stress management in the GMAs. Participants identified several positive aspects of each appointment type, which included convenience, supportive and enjoyable, and informative for GMAs and time and tailored information for IAs. Participants provided some suggestions to improve diabetes related-care for their respective appointment type. CONCLUSIONS Participants of GMAs and IAs for type 2 diabetes each reported unique strengths to their respective care plan and reported benefiting from their care.
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Affiliation(s)
- Anna Tataryn
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Hannah Derbowka
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Xinyu Shen
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Emily Gage
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Ester Kang
- Nutrition and Food Services, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - Jillian Wlock
- Sunrise Health and Wellness Centre, Saskatchewan Health Authority, Yorkton, Saskatchewan, Canada
| | - Jessica Lieffers
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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