1
|
Wiltshire C, Budzynska K, Kulkarni P, Shoyinka N, Perkins DW. Group medicare wellness visits: A pilot exploration of an approach to wellness and preventive medicine for older adults. Prev Med Rep 2023; 36:102514. [PMID: 38116253 PMCID: PMC10728448 DOI: 10.1016/j.pmedr.2023.102514] [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: 08/03/2023] [Revised: 11/08/2023] [Accepted: 11/10/2023] [Indexed: 12/21/2023] Open
Abstract
Introduction The Medicare annual wellness visit was designed to address health risks and encourage evidence-based preventive care in aging. However, it can be challenging for providers to dedicate time for comprehensive attention to wellness during these visits. Our project implements a group setting for Medicare wellness visits (GMWV) as an efficient method for delivering high value preventive care. Methods Three hundred patients from two primary care ambulatory clinics in Detroit, MI in need of their annual Medicare visit were invited to participate in the pilot GMWV. Fifty-eight patients agreed and completed their GMWV. The visit included collection of vitals, vision screening, and risk assessment during check-in, followed by educational wellness presentations led by an interdisciplinary team of six healthcare professionals. Patients completed a post visit-satisfaction survey and researchers calculated rates of completion of health maintenance gaps (HMG), i.e. immunizations and cancer screenings, among participants. Results The average age of participants (N female = 48) was 74 years old. Thirty-four participants had more than one HMG at baseline. On average, 8 % of immunization gaps and 12 % of screening gaps were completed at or within one-year post GMWV. Participant feedback reported that 82 % of patients felt that they learned something new from the presentation and 81 % of patients felt satisfied with the amount of time they spent with their physician. Discussion GMWV is a feasible approach to promoting wellness and healthy aging that patients find satisfying although, additional study is needed to compare the effectiveness of this model to standard care.
Collapse
Affiliation(s)
- Charis Wiltshire
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, 939 Woodward Avenue, Detroit, MI 48201, United States
| | - Katarzyna Budzynska
- Department of Family Medicine, Henry Ford Hospital, 3370 E Jefferson Ave, Detroit, MI 48207, United States
| | - Pooja Kulkarni
- Department of Family Medicine, Henry Ford Hospital, 3370 E Jefferson Ave, Detroit, MI 48207, United States
| | - Nike Shoyinka
- Department of Family Medicine, Henry Ford Hospital, 3370 E Jefferson Ave, Detroit, MI 48207, United States
| | - Denise White Perkins
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, 939 Woodward Avenue, Detroit, MI 48201, United States
- Department of Family Medicine, Henry Ford Hospital, 3370 E Jefferson Ave, Detroit, MI 48207, United States
| |
Collapse
|
2
|
Grundman JB, Majidi S, Perkins A, Streisand R, Monaghan M, Marks BE. Applying the use of shared medical appointments (SMAs) to improve continuous glucose monitor (CGM) use, glycemic control, and quality of life in marginalized youth with type 1 diabetes: Study protocol for a pilot prospective cohort study. Contemp Clin Trials Commun 2023; 32:101067. [PMID: 36698741 PMCID: PMC9868328 DOI: 10.1016/j.conctc.2023.101067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/08/2022] [Accepted: 01/14/2023] [Indexed: 01/18/2023] Open
Abstract
Background Continuous glucose monitors (CGMs) have been associated with improved glycemic control and diabetes-related quality of life in youth with type 1 diabetes (T1D), however use is lowest among youth from low-income households and racial/ethnic minorities. Shared medical appointments (SMAs) have been shown to improve glycemic control and reduce diabetes distress in adolescents with T1D, but a focus on marginalized youth has been lacking. This prospective cohort pilot study will assess feasibility and acceptability of the SMA intervention and impact on CGM uptake and sustained use, glycemic control, and diabetes distress in marginalized youth with elevated hemoglobin A1c (HbA1C). Methods The pilot study will recruit 20 publicly insured youth with T1D aged 8-12 years who identify as non-Hispanic Black or Latinx and have had at least one HbA1C value > 8% in the past year and their primary caretaker. The trial will employ an enrollment visit, SMA visits every 3 months over a 12-month study period, and a 6-month follow-up observational period. Feasibility measures include proportion of eligible youth successfully recruited for participation, proportion initiating CGM, SMA attendance, and retention through study completion. Acceptability will be assessed using satisfaction surveys. Changes in glycemic control will be assessed using CGM metrics and A1c from baseline to completion of the 12-month SMA intervention, as well as 3 and 6-months after completion of the SMA intervention. Conclusion Implementing SMAs for marginalized youth has the potential to address diabetes disparities by optimizing clinical and psychosocial outcomes for the most vulnerable youth living with T1D.Trial Registration: https://clinicaltrials.gov/ct2/show/NCT05431686.
Collapse
Affiliation(s)
- Jody B. Grundman
- Division of Endocrinology, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, USA,Corresponding author.
| | - Shideh Majidi
- Division of Endocrinology, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, USA,George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC, 20052, USA
| | - Amanda Perkins
- Division of Endocrinology, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, USA
| | - Randi Streisand
- Division of Endocrinology, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, USA,George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC, 20052, USA
| | - Maureen Monaghan
- Division of Endocrinology, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, USA
| | - Brynn E. Marks
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| |
Collapse
|
3
|
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
| |
Collapse
|
4
|
Aysola J, Rewley J, Xu C, Schapira M, Hubbard RA. Primary Care Patient Social Networks and Tobacco Use: An Observational Study. J Prim Care Community Health 2022; 13:21501327211037894. [PMID: 35120417 PMCID: PMC8819821 DOI: 10.1177/21501327211037894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/17/2021] [Accepted: 07/20/2021] [Indexed: 11/15/2022] Open
Abstract
IMPORTANCE Tobacco use remains the leading cause of preventable deaths and is susceptible to social influence. Yet, we know little about the characteristics of primary care social networks and how they influence tobacco use. OBJECTIVE To determine what primary care patient social network characteristics are associated with individual smoking behavior. DESIGN Cross-sectional. SETTING Two primary care practices in West Philadelphia, Pennsylvania (PA), USA. PARTICIPANTS A random sample of 53 primary care patients and 155 of their nominated social ties. MAIN OUTCOME AND MEASURES We examined the association between social network characteristics (degree, communicated weighted social ties, and presence of social reinforcement) and tobacco use history (never smoker, successful quitter, or current smoker). Other covariates included age, race/ethnicity, sex, education, income, and employment status, self-efficacy, depression status, provider-patient relationship. RESULTS Of those enrolled in our study (n = 208), 101 identified as never smokers, 59 as successfully quitters, and 48 as current smokers. Social reinforcements from connected alter pairs that never-smoked (OR = 1.20, 95% CI: 1.08, 1.34) was significantly associated with a participant being a never smoker. Participants with stronger ties with successful quitters were significantly more likely to identify as successfully quitting (OR = 1.37, 95% CI: 1.11, 1.69) and conversely had a negative association with stronger ties to unsuccessful quitters (OR = 0.59, 95% CI: 0.44, 0.80) or current smokers who had not tried to quit in the last year (OR = 0.82, 95% CI: 0.68, 0.98). Social reinforcement from connected pairs of alters that were unsuccessful quitters was significantly associated with the participant being a current smoker (OR = 1.26, 95% CI: 1.10, 1.45). CONCLUSIONS Our study suggests that smoking behaviors do not occur in isolation, nor because of 1 or 2 prominent social network members. Rather, our findings suggest that both strong ties and social reinforcement from clusters of similarly-behaving persons influence smoking behavior. Primary care practices have an opportunity to leverage these insights on patient networks to improve cancer prevention.
Collapse
Affiliation(s)
- Jaya Aysola
- Perelman School of Medicine, University
of Pennsylvania, Philadelphia, PA, USA
| | - Jeffrey Rewley
- Perelman School of Medicine, University
of Pennsylvania, Philadelphia, PA, USA
| | - Chang Xu
- Perelman School of Medicine, University
of Pennsylvania, Philadelphia, PA, USA
| | - Marilyn Schapira
- Perelman School of Medicine, University
of Pennsylvania, Philadelphia, PA, USA
| | - Rebecca A. Hubbard
- Perelman School of Medicine, University
of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
5
|
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.
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Schmidt MM, Griffin JM, McCabe P, Stuart-Mullen L, Branda M, OByrne TJ, Bowers M, Trotter K, McLeod C. Shared medical appointments: Translating research into practice for patients treated with ablation therapy for atrial fibrillation. PLoS One 2021; 16:e0246861. [PMID: 33577612 PMCID: PMC7880477 DOI: 10.1371/journal.pone.0246861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 01/27/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND People with atrial fibrillation (AF) have lower reported quality of life and increased risk of heart attack, death, and stroke. Lifestyle modifications can improve arrhythmia-free survival/symptom severity. Shared medical appointments (SMAs) have been effective at targeting lifestyle change in other chronic diseases and may be beneficial for patients with AF. OBJECTIVE To determine if perceived self-management and satisfaction with provider communication differed between patients who participated in SMAs compared to patients in standard care. Secondary objectives were to examine differences between groups for knowledge about AF, symptom severity, and healthcare utilization. METHODS We conducted a retrospective analysis of data collected where patients were assigned to either standard care (n = 62) or a SMA (n = 59). Surveys were administered at pre-procedure, 3, and 6 months. RESULTS Perceived self-management was not significantly different at baseline (p = 0.95) or 6 months (p = 0.21). Patients in SMAs reported more knowledge gain at baseline (p = 0.01), and higher goal setting at 6 months (p = 0.0045). Symptom severity for both groups followed similar trends. CONCLUSION Patients with AF who participated in SMAs had similar perceived self-management, patient satisfaction with provider communication, symptom severity, and healthcare utilization with their counterparts, but had a statistically significant improvement in knowledge about their disease.
Collapse
Affiliation(s)
- Monika M. Schmidt
- U.S. Department of Veteran’s Affairs, Nashville, TN, United States of America
| | | | - Pamela McCabe
- Mayo Clinic, Rochester, MN, United States of America
| | | | - Megan Branda
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Denver Anschutz Medical Campus, Aurora, CO, United States of America
| | | | | | | | | |
Collapse
|
8
|
Baqir W, Gray WK, Blair A, Haining S, Birrell F. Osteoporosis group consultations are as effective as usual care: Results from a non‐inferiority randomized trial. LIFESTYLE MEDICINE 2020. [DOI: 10.1002/lim2.3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Wasim Baqir
- Northumbria Healthcare NHS Foundation Trust Wansbeck General Hospital Ashington United Kingdom
| | - William K. Gray
- Northumbria Healthcare NHS Foundation Trust Wansbeck General Hospital Ashington United Kingdom
| | | | - Shona Haining
- North of England Commissioning Support (NECS) Newcastle United Kingdom
| | - Fraser Birrell
- Centre for Integrated Research into Musculoskeletal Ageing Newcastle University Newcastle upon Tyne United Kingdom
| |
Collapse
|
9
|
|
10
|
Ganetsky VS, Long JA, Mitra N, Chaiyachati KH, Kaufman ST. Impact of a Multidisciplinary, Endocrinologist-Led Shared Medical Appointment Model on Diabetes-Related Outcomes in an Underserved Population. Diabetes Spectr 2020; 33:74-81. [PMID: 32116457 PMCID: PMC7026762 DOI: 10.2337/ds19-0026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A multidisciplinary endocrinologist-led shared medical appointment (SMA) model showed statistically significant reductions in A1C from baseline over 3 years that were not significantly different from appointments with endocrinologists or primary care providers alone within a resource-poor population. Similarly, the SMA model achieved clinical outcomes on par with endocrinologist-only visits with the added benefit of improving endocrine provider productivity and specialty access for patients. Greater patient engagement with the SMA model was associated with significantly lower A1C.
Collapse
Affiliation(s)
| | - Judith A. Long
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Nandita Mitra
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA
| | - Krisda H. Chaiyachati
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Steven T. Kaufman
- Cooper University Hospital, Urban Health Institute, Camden, NJ
- Cooper Medical School of Rowan University, Camden, NJ
| |
Collapse
|
11
|
Russell-Westhead M, O'Brien N, Goff I, Coulson E, Pape J, Birrell F. Mixed methods study of a new model of care for chronic disease: co-design and sustainable implementation of group consultations into clinical practice. Rheumatol Adv Pract 2020; 4:rkaa003. [PMID: 32211579 PMCID: PMC7079718 DOI: 10.1093/rap/rkaa003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 01/10/2019] [Indexed: 12/11/2022] Open
Abstract
Objectives Group consultations are used for chronic conditions, such as inflammatory arthritis, but evidence of efficacy for treatment to target or achieving tight control is lacking. Our aim was to establish whether group consultation is a sustainable, co-designed routine care option and to explore factors supporting spread. Methods The study used mixed methods, observational process/outcome data, plus qualitative exploration of enabling themes. It was set in two community hospitals, in 2008–19, with a third hospital from 2016, and was triangulated with primary care qualitative data. There was a total of 3363 arthritis patient attendances at 183 clinics during 2008–19. The early arthritis cohort comprised 46 patients, followed monthly until the treatment target was achieved, during 2016–19. Focus groups included 15 arthritis and 11 osteoporosis group attendees. Intervention was a 2 h group consultation, attended monthly for early/active disease and annually for stable disease. Measurements included attendance, DAS, satisfaction and enabling themes. Results There was a mean number of 18.4 patients per clinic (n = 16, 2010–15; n = 18, 2016; n = 20, 2017; n = 23, 2018–19). Forty per cent (1161/2874) of patients with DAS data reached low disease activity (DAS < 3.2) or remission (DAS < 2.6). Forty-six early arthritis patients followed monthly until they achieved remission responded even better: 50% remission; and 89% low disease activity/remission by 6 months. Qualitative analysis derived five main enabling themes (efficiency, empathy, education, engagement and empowerment) and five promotors to translate these themes into practice (prioritization, personalization, participation, personality and pedagogy). Limitations included the prospectively collected observational data and pragmatic design susceptible to bias. Conclusion Co-designed group consultations can be sustainable, clinically effective and efficient for monthly review of early active disease and annual review of stable disease. Promoting factors may support effective training for chronic disease group consultations.
Collapse
Affiliation(s)
- Michele Russell-Westhead
- Medical Research Council Versus Arthritis Centre for Integrated Research into Musculoskeletal Ageing (CIMA), Newcastle University, Northumberland, UK.,Northumbria University, Newcastle upon Tyne, Northumberland, UK
| | - Nicola O'Brien
- Medical Research Council Versus Arthritis Centre for Integrated Research into Musculoskeletal Ageing (CIMA), Newcastle University, Northumberland, UK.,Northumbria University, Newcastle upon Tyne, Northumberland, UK
| | - Iain Goff
- Rheumatology, Northumbria Healthcare NHS Foundation Trust, Northumberland, UK
| | - Elizabeth Coulson
- Rheumatology, Northumbria Healthcare NHS Foundation Trust, Northumberland, UK
| | - Jess Pape
- Rheumatology, Northumbria Healthcare NHS Foundation Trust, Northumberland, UK
| | - Fraser Birrell
- Medical Research Council Versus Arthritis Centre for Integrated Research into Musculoskeletal Ageing (CIMA), Newcastle University, Northumberland, UK.,Rheumatology, Northumbria Healthcare NHS Foundation Trust, Northumberland, UK
| |
Collapse
|
12
|
Shared Medical Appointments in Preoperative Joint Replacement: Assessing Patient and Healthcare Member Satisfaction. J Healthc Qual 2019; 41:329-336. [PMID: 31082931 DOI: 10.1097/jhq.0000000000000205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Shared medical appointments (SMAs) have proven to be effective in improving patient access and education while augmenting productivity. In shifting from a traditional visit model, patient and interdisciplinary healthcare team (IHCT) member satisfaction is imperative. Predominantly seen in primary care, SMA use in orthopedics is limited. After identification of access and productivity concerns, the SMA was implemented as a quality improvement project in a rural clinic. The lower extremity joint replacement (LEJR) population was chosen because of multiple preoperative appointments and costs on the healthcare system. PURPOSE To assess patients' and IHCT members' satisfaction levels in using an SMA for the preparation of LEJR. RELEVANCE TO HEALTHCARE QUALITY The SMA is an effective model offering an efficient, cost-effective methodology aligning with the Institute for Healthcare Improvement's Triple Aim. RESULTS Twenty SMAs were conducted. Sixty-three patients and 14 ICHT members participated. Mean (M) satisfaction rating for SMA patients (M = 4.90, SD 0.26) was significantly higher than mean for traditional patients (M = 4.03, SD 0.39). Interdisciplinary healthcare team members' attitudes toward SMAs revealed a mean score of 4.58. Incidentally, cycle times improved as did lengths of stay. CONCLUSIONS Lower extremity joint replacement patients and IHCT members reported high satisfaction with SMAs.
Collapse
|
13
|
Parikh M, Rajendran I, D'Amico S, Luo M, Gardiner P. Characteristics and Components of Medical Group Visits for Chronic Health Conditions: A Systematic Scoping Review. J Altern Complement Med 2019; 25:683-698. [PMID: 30945935 DOI: 10.1089/acm.2018.0524] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objectives: Chronic health conditions are a major challenge to the health care system. Medical Group Visits (MGVs) are a valuable health care delivery model used in a variety of medical settings and patient populations. We conducted a systematic scoping review of MGV research literature for chronic health conditions to summarize the characteristics and individual components of MGVs in the United States of America and Canada. Design: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses scoping review methodology and searched five databases using nine widely used MGV-related terms. Subjects: We included studies conducted in the United States and Canada, whose participants were >18 years old and attended an MGV conducted in a medical setting by a billable health care provider. We excluded groups related to diabetes, pregnancy, and cancer. Results: Of 3777 studies identified, we found 55 eligible studies of which 9 are randomized controlled trials and 46 are observational studies. The majority of studies were conducted in academic medical centers, were observational in design, and recruited patients using physician referrals. The three most frequently studied groups include a combination of several chronic conditions (n = 12), chronic pain conditions (n = 10), and cardiovascular disease (n = 9). Curriculum components included didactics (n = 55), experiential activities (n = 27), and socializing components (n = 12). Didactic areas include (1) medical topics such as symptoms management (n = 27) of which 14 included pain management, and (2) lifestyle/educational component (n = 33) that comprised of talks on nutrition (n = 29), exercise (n = 20), stress (n = 16), and sleep (n = 10). The top integrative medicine (IM) modalities (n = 13) included: mindfulness techniques (n = 8), meditation (n = 6), and yoga (n = 5). Substantial heterogeneity was observed in the recruitment, implementation, curriculum components, and outcomes reported. Conclusion: The MGV is a model of patient-centered care that has captured the attention of researchers. IM modalities are well represented in the curriculum components of MGVs. Further investigation into the components identified by this study, may help in better targeting of group interventions to patients and contexts, where it is most likely to be effective.
Collapse
Affiliation(s)
- Manasi Parikh
- 1Department of Family Medicine and Boston Medical Center, Boston, MA
| | - Iniya Rajendran
- 2Department of Internal Medicine, Boston Medical Center, Boston, MA
| | - Salvatore D'Amico
- 1Department of Family Medicine and Boston Medical Center, Boston, MA
| | - Man Luo
- 1Department of Family Medicine and Boston Medical Center, Boston, MA
| | - Paula Gardiner
- 3Department of Family Medicine and Community Health, UMass Memorial Health Care, University of Massachusetts Medical School, Worcester, MA
| |
Collapse
|
14
|
Griffin JM, Stuart-Mullen LG, Schmidt MM, McCabe PJ, O'Byrne TJ, Branda ME, McLeod CJ. Preparation for and Implementation of Shared Medical Appointments to Improve Self-Management, Knowledge, and Care Quality Among Patients With Atrial Fibrillation. Mayo Clin Proc Innov Qual Outcomes 2018; 2:218-225. [PMID: 30225453 PMCID: PMC6132214 DOI: 10.1016/j.mayocpiqo.2018.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/08/2018] [Accepted: 06/15/2018] [Indexed: 06/08/2023] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia in adults and is associated with an increased risk of stroke, heart failure, and death. Therapy for this pervasive arrhythmia is complex, involving multiple options that chiefly manage symptoms and prevent stroke. Current therapeutic strategies are also of limited efficacy, and can present potentially life-threatening side effects and/or complications. Emerging research suggests that the burden of AF can be reduced by improving patient understanding of the arrhythmia and teaching patients to adopt and maintain lifestyle and behavior changes. Shared medical appointments (SMAs) have been successfully used to deliver education and develop patient coping and disease management skills for patients with complex needs, but there is a paucity of studies examining the use of SMAs for managing AF. Moreover, few studies have examined strategies for implementing SMAs into routine clinical care. We detail our approach for (1) adapting a patient-centered SMA curriculum; (2) designing an evaluation comparing SMAs to routine care on patient outcomes; and (3) implementing SMAs into routine clinical practice. We conclude that evaluation and implementation of SMAs into routine clinical practice requires considerable planning and continuous engagement from committed key stakeholders, including patients, family members, schedulers, clinical staff, nurse educators, administrators, and billing specialists.
Collapse
|
15
|
McClain MR, Klingensmith GJ, Anderson B, Berget C, Cain C, Shea J, Campbell K, Pyle L, Raymond JK. Team Clinic: Group Approach to Care of Early Adolescents With Type 1 Diabetes. Diabetes Spectr 2018; 31:273-278. [PMID: 30140144 PMCID: PMC6092886 DOI: 10.2337/ds17-0063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Georgeanna J. Klingensmith
- Barbara Davis Center for Diabetes, University of Colorado, Department of Pediatrics, Anschutz Medical Campus, Aurora, CO
| | - Barbara Anderson
- Baylor College of Medicine/Texas Children’s Hospital, Houston, TX
| | - Cari Berget
- Barbara Davis Center for Diabetes, University of Colorado, Department of Pediatrics, Anschutz Medical Campus, Aurora, CO
| | - Cindy Cain
- Barbara Davis Center for Diabetes, University of Colorado, Department of Pediatrics, Anschutz Medical Campus, Aurora, CO
| | - Jacqueline Shea
- Barbara Davis Center for Diabetes, University of Colorado, Department of Pediatrics, Anschutz Medical Campus, Aurora, CO
| | - Kristen Campbell
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO
| | - Laura Pyle
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, CO
| | - Jennifer K. Raymond
- Los Angeles Children’s Hospital, University of Southern California, Keck School of Medicine, Los Angeles, CA
| |
Collapse
|
16
|
Hartzler ML, Shenk M, Williams J, Schoen J, Dunn T, Anderson D. Impact of Collaborative Shared Medical Appointments on Diabetes Outcomes in a Family Medicine Clinic. DIABETES EDUCATOR 2018; 44:361-372. [DOI: 10.1177/0145721718776597] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose The purpose of this study is to evaluate the impact of a collaborative diabetes shared medical appointment on patient outcomes in an urban family medicine practice. Methods Fifty-nine patients were enrolled to participate in multiple shared medical appointments (SMAs) over 12 months. Baseline data included hemoglobin (A1C), lipids, systolic blood pressure (SBP), weight, adherence to American Diabetes Association (ADA) guidelines, and surveys, including the Problem Areas in Diabetes (PAID-2) scale and the Spoken Knowledge in Low Literacy in Diabetes Scale (SKILLD). A1C and SBP were evaluated at each visit. Lipid control was assessed at baseline and at 6 and 12 months. Adherence to ADA guidelines, SKILLD and PAID-2 survey scores, and number of antihyperglycemic and antihypertensive medications were also evaluated at 12 months. Results Thirty-eight patients completed the study. Compared with baseline, A1C and low-density lipoprotein cholesterol (LDL-C) levels decreased significantly over 12 months ( P < .001 and P = .004, respectively). More patients became compliant with the ADA guidelines throughout the course of the study. Specifically, more patients achieved the LDL-C goal of ≤100 mg/dL (2.59 mmol/L; P < .001), were prescribed appropriate antihypertensive medications ( P < .001) and aspirin ( P < .001), and received the pneumonia vaccine ( P < .001). PAID-2 and SKILLD survey scores also significantly improved over the course of the study ( P ≤ .001 and P = .003, respectively). Conclusion Short-term interdisciplinary SMAs decreased A1C and LDL-C, improved patient adherence to ADA guidelines, improved emotional distress related to diabetes, and increased knowledge of diabetes.
Collapse
Affiliation(s)
| | - McKenzie Shenk
- Cedarville University School of Pharmacy, Cedarville, Ohio
| | - Julie Williams
- Wright State University, School of Professional Psychology, Dayton, Ohio
| | - James Schoen
- Grandview Medical Center, Family Medicine, Dayton, Ohio
| | - Thomas Dunn
- Kettering Physicians Network, Family Medicine, Dayton, Ohio
| | | |
Collapse
|
17
|
Reid MW, Krishnan S, Berget C, Cain C, Thomas JF, Klingensmith GJ, Raymond JK. CoYoT1 Clinic: Home Telemedicine Increases Young Adult Engagement in Diabetes Care. Diabetes Technol Ther 2018; 20:370-379. [PMID: 29672162 DOI: 10.1089/dia.2017.0450] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Young adults with type 1 diabetes (T1D) experience poor glycemic control, disengagement in care, and are often lost to the medical system well into their adult years. Diabetes providers need a new approach to working with the population. The goal of this study was to determine whether an innovative shared telemedicine appointment care model (CoYoT1 Clinic [pronounced as "coyote"; Colorado Young Adults with T1D]) for young adults with T1D improves care engagement, satisfaction, and adherence to American Diabetes Association (ADA) guidelines regarding appointment frequency. SUBJECTS AND METHODS CoYoT1 Clinic was designed to meet the diabetes care needs of young adults (18-25 years of age) with T1D through home telemedicine. Visits occurred every 3 months over the 1-year study (three times by home telemedicine and one time in-person). Outcomes were compared to patients receiving treatment as usual (control). RESULTS Compared with controls, CoYoT1 patients attended significantly more clinic visits (P < 0.0001) and increased their number of clinic visits from the year before the intervention. Seventy-four percent of CoYoT1 patients were seen four times over the 12-month study period, meeting ADA guidelines, but none in the control group met the ADA recommendation. CoYoT1 patients used diabetes technologies more frequently and reported greater satisfaction with care compared with controls. CONCLUSIONS Delivering diabetes care by home telemedicine increases young adults' adherence to ADA guidelines and usage of diabetes technologies, and improves retention in care when compared to controls. Home telemedicine may keep young adults engaged in their diabetes care during this challenging transition period.
Collapse
Affiliation(s)
- Mark W Reid
- 1 Department of Surgery, Division of Ophthalmology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California , Los Angeles, California
| | - Subramanian Krishnan
- 1 Department of Surgery, Division of Ophthalmology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California , Los Angeles, California
| | - Cari Berget
- 2 Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado , Aurora, Colorado
| | - Cindy Cain
- 2 Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado , Aurora, Colorado
| | - John Fred Thomas
- 3 Department of Telehealth, School of Medicine, University of Colorado , Aurora, Colorado
- 4 Department of Psychiatry, School of Medicine, University of Colorado , Aurora, Colorado
- 5 Department of Epidemiology, School of Public Health, University of Colorado , Aurora, Colorado
| | - Georgeanna J Klingensmith
- 2 Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado , Aurora, Colorado
| | - Jennifer K Raymond
- 6 Department of Pediatrics, Division of Endocrinology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California , Los Angeles, California
| |
Collapse
|
18
|
Bottino CJ, Puente GC, Burrage A, Tannis C, Cheng JK, Epee-Bounya A, Cox JE. Primary Care Group Visits for Childhood Obesity: Clinical Program Evaluation. Clin Pediatr (Phila) 2018; 57:442-450. [PMID: 28929794 DOI: 10.1177/0009922817728696] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We conducted 29 group visits targeting children with elevated body mass index (BMI) and their families. Visit activities focused on social support, mind-body techniques, exercise, and nutrition. Measures included attendance, family satisfaction scores, and per-patient change in BMI percentile. Ninety-six patients attended ≥1 group visit, mean 2.0 (SD ±1.8; range 1-14). Mean patient age was 9.6 years (SD ±2.4; range 4-15 years); 53.1% were female; 44.8% had a BMI 95th to 99th percentile for age/sex; 35.4% had a BMI >99th percentile. Mean attendance per group visit was 6.8 patients (SD ±3.8; range 1-16 patients). Mean family satisfaction scores were 9.8 (SD ±0.8) with 10/10 "would recommend to family or friends." Of 42 patients who attended ≥2 group visits, 5 (11.9%) experienced a ≥5 BMI percentile reduction between first and last visits; 3 (7.1%) maintained this reduction 2 years later. Group visits were associated with high family satisfaction scores, though few patients experienced a reduction in BMI percentile.
Collapse
Affiliation(s)
- Clement J Bottino
- 1 Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
| | - Gabriella C Puente
- 1 Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Amanda Burrage
- 3 Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Candace Tannis
- 3 Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jennifer K Cheng
- 1 Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
| | - Alexandra Epee-Bounya
- 1 Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
| | - Joanne E Cox
- 1 Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
| |
Collapse
|
19
|
Giramonti KM, Kogan BA. Early experience with shared medical appointments for penile problems. J Pediatr Urol 2018; 14:81-83. [PMID: 29191660 DOI: 10.1016/j.jpurol.2017.09.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/29/2017] [Indexed: 11/17/2022]
Abstract
We examined the use of shared medical appointments (SMA) for educating and counseling children with penile problems. Forty-eight families were seen over 4 months with 21 participating in the SMA group and 27 in the traditional group. Using a questionnaire to assess adequacy of education, there was no difference in the overall scores between groups with a mean of 6.64/7 in the SMA and 6.56/7 in the traditional setting. With the increasing demands on providers, an SMA offers a solution to caring for more patients with penile problems in an efficient manner without impacting family education and satisfaction.
Collapse
Affiliation(s)
| | - Barry A Kogan
- Albany Medical Center Division of Urology, Albany, NY, USA
| |
Collapse
|
20
|
Bauer NS, Azer N, Sullivan PD, Szczepaniak D, Stelzner SM, Downs SM, Carroll AE. Acceptability of Group Visits for Attention-Deficit Hyperactivity Disorder in Pediatric Clinics. J Dev Behav Pediatr 2017; 38:565-572. [PMID: 28816910 PMCID: PMC5657442 DOI: 10.1097/dbp.0000000000000492] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Children with attention-deficit hyperactivity disorder (ADHD) have ongoing needs that impair home and school functioning. Group visit models are a promising way to deliver timely parenting support but family and provider acceptance has not previously been examined. The objective was to describe the acceptability of ADHD group visits in busy pediatric clinics based on caregivers, child participants and facilitators. METHODS Data were analyzed from school-age children and caregivers who participated in one of two 12-month long randomized controlled studies of the ADHD group visit model from 2012 to 2013 or 2014 to 2015. Feedback was obtained using semi-structured questions at each study end, by telephone or at the last group visit. Sessions were audio-recorded, transcribed and themes were extracted by participant type. RESULTS A total of 34 caregivers, 41 children and 9 facilitators offered feedback. Caregivers enjoyed the "support group" aspect and learning new things from others. Caregivers reported improved understanding of ADHD and positive changes in the relationship with their child. Children were able to recall specific skills learned including how skills helped at home or school. Facilitators acknowledged systems-level challenges to offering group visits but felt the group format helped increase understanding of families' needs, improved overall care, and provided innovative ways to engage with families. CONCLUSION The majority of comments from families and facilitators highlighted a variety of benefits of the use of a group visit model for ADHD chronic care. Despite systems-level barriers to implementation, families and facilitators felt the benefits outweighed the challenges.
Collapse
Affiliation(s)
- Nerissa S. Bauer
- Department of Pediatrics, Indiana University School of Medicine, Section of Children’s Health Services Research, Indianapolis, IN
- Center for Health Services Research, Regenstrief Institute Inc., Indianapolis, IN
| | - Nina Azer
- Department of Pediatrics, University of Kentucky, Lexington, KY
| | - Paula D. Sullivan
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | - Dorota Szczepaniak
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | | | - Stephen M. Downs
- Department of Pediatrics, Indiana University School of Medicine, Section of Children’s Health Services Research, Indianapolis, IN
- Center for Health Services Research, Regenstrief Institute Inc., Indianapolis, IN
| | - Aaron E. Carroll
- Center for Health Services Research, Regenstrief Institute Inc., Indianapolis, IN
- Department of Pediatrics, Indiana University School of Medicine, Section of Pediatric and Adolescent Comparative Effectiveness Research, Indianapolis, IN
| |
Collapse
|
21
|
Gagnon A, Jin M, Malak M, Bednarowski K, Feng L, Francis-Pringle S, Lu S, Mallin A, Skokovic-Sunjic D, Vedelago A. Pharmacists Managing People with Diabetes in Primary Care: 10 Years of Experience at the Hamilton Family Health Team. Can J Diabetes 2017; 41:576-579. [PMID: 28935357 DOI: 10.1016/j.jcjd.2017.08.240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 08/16/2017] [Accepted: 08/16/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Antony Gagnon
- Hamilton Family Health Team, Hamilton, Ontario, Canada; Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.
| | - Margaret Jin
- Hamilton Family Health Team, Hamilton, Ontario, Canada; Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Mark Malak
- Hamilton Family Health Team, Hamilton, Ontario, Canada
| | | | - Lucy Feng
- Hamilton Family Health Team, Hamilton, Ontario, Canada
| | | | - Sandy Lu
- Hamilton Family Health Team, Hamilton, Ontario, Canada
| | - Anne Mallin
- Hamilton Family Health Team, Hamilton, Ontario, Canada
| | | | | |
Collapse
|
22
|
Trickett KH, Matiaco PM, Jones K, Howlett B, Early KB. Effectiveness of Shared Medical Appointments Targeting the Triple Aim Among Patients With Overweight, Obesity, or Diabetes. J Osteopath Med 2017; 116:780-787. [PMID: 27893144 DOI: 10.7556/jaoa.2016.153] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Obesity and diabetes are epidemic in the United States, with many treatment options having limited long-term efficacy. A possible effective medical management tool is the shared medical appointment (SMA), which offers an efficient and cost-effective approach to behavior change and aligns with the Triple Aim (reduce costs, improve population health, and improve patient care experience) set forth by the Institute for Healthcare Improvement. OBJECTIVES To assess the effectiveness of SMAs to achieve the Triple Aim and to improve the management of overweight/obesity or diabetes. METHODS Peer-reviewed literature from PubMed was searched by the keywords shared medical appointments, group medical appointment, and group medical visit, with no date restrictions and limited to English publications with sample sizes greater than or equal to 20. RESULTS Eight articles met inclusion criteria. The Triple Aim was not referenced in the studies, but most reported some combination of reduced costs, improved care, and improved outcomes or patient satisfaction. CONCLUSIONS Potential benefits of SMAs include improved patient outcomes and satisfaction. Osteopathic and, in particular, primary care medicine could likely benefit from moving toward greater adoption of SMAs; however, more randomized controlled trials are needed to assess their effectiveness with regard to the Triple Aim.
Collapse
|
23
|
Nathan TA, Cohen AD, Vinker S. A new marker of primary care utilization - annual accumulated duration of time of visits. Isr J Health Policy Res 2017; 6:35. [PMID: 28793928 PMCID: PMC5550929 DOI: 10.1186/s13584-017-0159-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 06/07/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Most of the research on primary care workload has focused on the number of visits or the average duration of visits to a primary care physician (PCP) and their effect on the quality of medical care. However, the accumulated annual visit duration has yet to be examined. This measure could also have implications for the allocation of resources among health plans and across regions. In this study we aimed to define and characterize the concept of "Accumulated Annual Duration of Time" (AADT) spent with a PCP. METHOD: A cross-sectional study based on a national random sample of 77,247 adults aged 20 and over. The study's variables included annual number of visits and AADT with a PCP, demographic characteristics and chronic diseases. The time period was the entire year of 2012. RESULTS For patients older than 20 years, the average annual number of visits to a PCP was 8.8 ± 9.1, and the median 6 ± 10 IQR (Interquartile Range). The mean AADT was 65.8 ± 75.7 min, and the median AADT was 43 ± 75 IQR minutes. The main characteristics of patients with a higher annual number of visits and a higher AADT with a PCP were: female, older in age, a higher Charlson index and a low socio-economic status. Chronic diseases were also found to increase the number of annual visits to a PCP as well as the AADT, patients with chronic heart failure had highest AADT in comparison to others (23.1 ± 15.5 vs. 8.6 ± 8.9 visits; and 165.3 ± 128.8 vs. 64.5 ± 74 min). It was also found that the relationship between AADT and age was very similar to the relationship between visits and age. CONCLUSION While facing the ongoing increase in a PCP's work load and shortening of visit length, the concept of AADT provides a new measure to compare between different healthcare systems that allocate different time frames for a single primary care visit. For Israel, the analysis of the AADT data provides support for continued use of the number of visits in the capitation formula, as a reliable and readily-accessible indicator of primary care usage.
Collapse
Affiliation(s)
- Talya A. Nathan
- The Department of Family Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arnon D. Cohen
- Clalit Health Services, Tel Aviv; 3) Medical Division, Leumit Health Services, Tel Aviv, Israel
| | - Shlomo Vinker
- The Department of Family Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
24
|
Coates J, Gething F, Johnson MI. Shared medical appointments for managing pain in primary care settings? Pain Manag 2017; 7:223-227. [PMID: 28699374 DOI: 10.2217/pmt-2017-0016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Jonathan Coates
- St. Anthony's Health Centre, St. Anthony's Road, Walker, Newcastle NE6 2NN, UK
| | - Fraser Gething
- Pain Management Team, Newcastle upon Tyne Hospitals NHS Foundation Trust, Elswick Health Centre, Newcastle upon Tyne NE4 6SH, UK
| | - Mark I Johnson
- Centre for Pain Research, School of Clinical & Applied Sciences, Leeds Beckett University City Campus, Leeds LS1 3HE, UK
| |
Collapse
|
25
|
Raymond JK. Models of Care for Adolescents and Young Adults with Type 1 Diabetes in Transition: Shared Medical Appointments and Telemedicine. Pediatr Ann 2017; 46:e193-e197. [PMID: 28489225 DOI: 10.3928/19382359-20170425-01] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Transitioning through adolescence and young adulthood is challenging, and even more so for patients living with a chronic disease such as type 1 diabetes. Patients in this age group encounter multiple obstacles to effectively managing their diabetes, experience suboptimal glycemic control, face higher rates of acute complications, and are often lost to medical follow-up. Comprehensive strategies and innovative clinical models are needed to engage this population in diabetes medical care, address barriers to ideal management, and improve outcomes. Telemedicine, shared medical appointments (SMA), or a combination of telemedicine and SMA are potential models to more successfully, efficiently, and satisfactorily address the urgent need for improved care in this high-risk population. This article reviews various clinical care models within these categories of telemedicine and SMA. [Pediatr Ann. 2017;46(5):e193-e197.].
Collapse
|
26
|
Berget C, Lindwall J, Shea JJ, Klingensmith GJ, Anderson BJ, Cain C, Raymond JK. Team Clinic: An Innovative Group Care Model for Youth with Type 1 Diabetes-Engaging Patients and Meeting Educational Needs. J Nurse Pract 2017; 13:e269-e272. [PMID: 28993721 DOI: 10.1016/j.nurpra.2017.03.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The purpose of this pilot was to implement an innovative group care model, "Team Clinic", for adolescents with type 1 diabetes and assess patient and provider perspectives. Ninety-one intervention patients and 87 controls were enrolled. Ninety-six percent of intervention adolescents endorsed increased support and perceived connecting with peers as important. The medical providers and staff also provided positive feedback stating Team Clinic allowed more creativity in education and higher quality of care. Team Clinic may be a promising model to engage adolescents and incorporate education and support into clinic visits in a format valued by patients and providers.
Collapse
Affiliation(s)
- Cari Berget
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Department of Pediatrics, 1775 Aurora Court, Aurora, CO, 80045
| | - Jennifer Lindwall
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Department of Pediatrics, 1775 Aurora Court, Aurora, CO, 80045
| | - Jacqueline J Shea
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Department of Pediatrics, 1775 Aurora Court, Aurora, CO, 80045
| | - Georgeanna J Klingensmith
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Department of Pediatrics, 1775 Aurora Court, Aurora, CO, 80045
| | - Barbara J Anderson
- Baylor College of Medicine/Texas Children's Hospital, Professor of Pediatrics, Associate Head Psychology Section, 1 Baylor Plaza, Houston, TX, 77030
| | - Cindy Cain
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Department of Pediatrics, 1775 Aurora Court, Aurora, CO, 80045
| | - Jennifer K Raymond
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Department of Pediatrics, 1775 Aurora Court, Aurora, CO, 80045
| |
Collapse
|
27
|
Zahedi FM, Walia N, Jain H. Augmented Virtual Doctor Office: Theory-based Design and Assessment. J MANAGE INFORM SYST 2016. [DOI: 10.1080/07421222.2016.1243952] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
28
|
Batsis JA, Naslund JA, Gill LE, Masutani RK, Agarwal N, Bartels SJ. Use of a Wearable Activity Device in Rural Older Obese Adults: A Pilot Study. Gerontol Geriatr Med 2016; 2:2333721416678076. [PMID: 28138502 PMCID: PMC5120773 DOI: 10.1177/2333721416678076] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 09/22/2016] [Accepted: 10/04/2016] [Indexed: 12/30/2022] Open
Abstract
Objective: Assess the feasibility and acceptability of Fitbit for supporting behavioral change in rural, older adults with obesity. Method: Eight adults aged ≥65 with a body mass index (BMI) ≥30kg/m2 were recruited from a rural practice and provided a Fitbit Zip device for 30 days. Participants completed validated questionnaires/interviews. Results: Mean age was 73.4 ± 4.0 years (50% female) with a mean BMI of 34.5 ± 4.5kg/m2. We observed reductions in exercise confidence (sticking to it: 34.5 ± 3.3 to 30.9 ± 4.3, p = .04; making time: 18.9 ± 1.3 to 17.0 ± 2.6, p = .03) but no changes in patient activation (45.4 ± 4.3 vs. 45.0 ± 3.9). All reported high satisfaction, seven (87.5%) found Fitbit easy to use, and five (62.5%) found the feedback useful. The majority (n = 6 [75.0%]) were mostly/very satisfied with the intervention. Consistent themes emerged regarding the benefit of self-monitoring and participant motivation. Common concerns included finding time to exercise and lack of a peer group. Conclusion: Use of Fitbit is feasible/acceptable for use among older rural obese adults but may lead to reduced confidence.
Collapse
Affiliation(s)
- John A Batsis
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA; The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
| | - John A Naslund
- Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
| | - Lydia E Gill
- Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
| | | | - Nayan Agarwal
- Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Stephen J Bartels
- Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
| |
Collapse
|
29
|
Social and Support Services Offered by Cleft and Craniofacial Teams: A National Survey and Institutional Experience. J Craniofac Surg 2016; 27:356-60. [PMID: 26825746 DOI: 10.1097/scs.0000000000002385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND A multidisciplinary approach to patients with craniofacial abnormalities is the standard of care by the American Cleft Palate-Craniofacial Association (ACPA). The standards of team care, however, do not require provision of social support services beyond access to a social worker. The purpose of this investigation is to study social support services provided by ACPA teams, funding sources for services, and family interest in services. METHODS A survey was submitted to ACPA cleft and craniofacial team leaders (N = 161), which evaluated the provision of potentially beneficial social support services, and their funding sources. A second survey administered to patient families at our institution gauged their level of interest in these services. Statistical analysis evaluated the level of interest among services. RESULTS Seventy-five of 161 (47%) teams and 39 of 54 (72%) families responded to the surveys. Services provided included scholarships (4%), summer camp (25%), social media (32%), patient support groups (36%), parties (42%), parent support groups (46%), other opportunities (56%), and social workers (90%). The majority of funding for social workers was by the institution (61%) whereas funding for ancillary services varied (institution, team, fundraisers, grants, and other sources). Families indicated an average interest of 2.4 ± 1.41 for support groups, 2.5 ± 1.63 for summer camps, 2.92 ± 1.66 for parties, 3.16 ± 1.65 for social media, and 3.95 ± 1.60 for scholarships (P value <0.05). CONCLUSIONS The ACPA standards of team care do not require teams to provide social support services beyond access to a social worker. Among our survey respondents, the authors found that in addition to a social worker, teams offered social support services, which were not required. The social worker position is usually institutionally funded, whereas funding sources for additional services varied. Respondents at our center desired additional social support services. The authors recommend a hybrid model of hospital and nonhospital funding to provide social and support services to patients with craniofacial deformities.
Collapse
|
30
|
Do Patient-Centered Medical Home Access and Care Coordination Measures Reflect the Contribution of All Team Members? A Systematic Review. J Nurs Care Qual 2016; 31:357-66. [DOI: 10.1097/ncq.0000000000000192] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
31
|
Damaske D, McCrossin P, Santoro F, Alcantara J. The beliefs and attitudes of chiropractors and their patients utilising an open practice environment. Eur J Integr Med 2016. [DOI: 10.1016/j.eujim.2016.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
32
|
Balduino ADFA, Mantovani MDF, Lacerda MR, Marin MJS, Wal ML. Experience of hypertensive patients with self-management of health care. J Adv Nurs 2016; 72:2684-2694. [PMID: 27206159 DOI: 10.1111/jan.13022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2016] [Indexed: 11/28/2022]
Abstract
AIMS The aim of this study was to interpret how hypertensive patients experience health care self-management. BACKGROUND Hypertension is one of the most prevalent chronic diseases worldwide. The involvement of individuals in the management of their health care to treat this disease is fundamental, with aid and advice from healthcare professionals, especially nurses, so that hypertensive patients can effectively self-manage their health care. DESIGN Qualitative study. METHODS Hypertensive patients were recruited using theoretical sampling. The study sample consisted of 28 hypertensive patients aged 18-59 years who were registered in the e-Health programme of the Ministry of Health. Data were collected and analyzed between September 2012-October 2014 using a semi-structured interview based on the methodological framework of the constructivist grounded theory. FINDINGS The participants' statements depicted an outline of their experience with the disease: the beginning of the illness; understanding the disease process; incorporating behaviour for self-management of the disease; experiencing attitudes and actions in the control and treatment of the disease; and being treated in the public healthcare system. A central phenomenon emerged, namely hypertensive patients' experience of self-management of health care. CONCLUSION This phenomenon has paths, actions and interactions. When patients discover that they have the disease and become aware of the disease process, they assume the identity of being hypertensive and become proactive in their health care and in living with their families and in communities.
Collapse
|
33
|
Raymond JK, Berget CL, Driscoll KA, Ketchum K, Cain C, “Fred” Thomas JF. CoYoT1 Clinic: Innovative Telemedicine Care Model for Young Adults with Type 1 Diabetes. Diabetes Technol Ther 2016; 18:385-90. [PMID: 27196443 PMCID: PMC5583551 DOI: 10.1089/dia.2015.0425] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Young adults with type 1 diabetes (T1D) face many challenges in managing their diabetes, resulting in suboptimal glycemic control and often loss to follow-up. Comprehensive strategies are needed to engage this population in diabetes care and improve outcomes. This pilot study investigated the feasibility and acceptability of the Colorado Young Adults with Type 1 Diabetes (CoYoT1) Clinic-an innovative clinical care model for young adults with T1D, incorporating telemedicine and peer interactions. SUBJECTS AND METHODS Forty-five patients with T1D, 18-25 years of age, participated in this study. Patients completed one routine, diabetes clinic appointment, using Health Insurance Portability and Accountability-approved, Web-based videoconferencing from a location of their choosing. The clinic visit consisted of an individual appointment with a diabetes provider and a group appointment with other young adults, facilitated by a certified diabetes educator. Patients completed a satisfaction survey and reported the time lost from school or work to complete the virtual appointment compared with time typically lost to complete a traditional, in-person, visit. RESULTS Patients reported high levels of satisfaction with the virtual clinic and high levels of perceived support from the peer interaction. Additionally, patients reported saving over 6 h from their work or school day when completing their diabetes clinic visit virtually instead of in-person. CONCLUSIONS In this cross-sectional pilot study, the CoYoT1 Clinic, incorporating Web-based videoconferencing and peer interactions, was feasible and acceptable for young adults with T1D. This model may potentially increase engagement with diabetes care in the young adult population. However, further research is needed to fully evaluate the intervention.
Collapse
Affiliation(s)
- Jennifer K. Raymond
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Cari L. Berget
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kimberly A. Driscoll
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kaitlin Ketchum
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Cynthia Cain
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - John F. “Fred” Thomas
- Department of Telehealth, Children's Hospital Colorado, Aurora, Colorado
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado
- Department of Epidemiology, University of Colorado School of Public Health, Aurora, Colorado
| |
Collapse
|
34
|
Affiliation(s)
- Nancy M. Albert
- From the Office of Nursing Research and Innovation, Nursing Institute, Cleveland Clinic Health System and Kaufman Center for Heart Failure, Heart and Vascular Institute, OH
| |
Collapse
|