Development and implementation of group medical visits at a family medicine center

2006 ◽  
Vol 63 (15) ◽  
pp. 1448-1452 ◽  
Author(s):  
Stephanie Barud ◽  
Todd Marcy ◽  
Becky Armor ◽  
Jennifer Chonlahan ◽  
Paige Beach
Keyword(s):  
Family Medicine ◽  
Group Medical Visits ◽  
Medical Visits

scholarly journals Group Medical Visit Training in Family Medicine Residency:

2019 ◽  
Vol 51 (4) ◽  
pp. 319-325 ◽  
Author(s):  
Carmen Strickland ◽  
Joanne C. Sandberg ◽  
Stephen W. Davis ◽  
Sally P. Weaver
Keyword(s):  
Family Medicine ◽  
Program Directors ◽  
Resident Training ◽  
Training Methods ◽  
Medical Visit ◽  
Patient Centered ◽  
Family Medicine Residency ◽  
Group Medical Visits ◽  
Medical Visits ◽  
The Status

Background and Objectives: Group medical visits (GMV) have been shown to improve clinical outcomes and patient satisfaction and are included as a new tool in the patient-centered medical home (PCMH). The capacity for and interest in developing GMV skills in family medicine residency have not been assessed. This study aims to describe the extent of existing training in GMV as well as attitudes toward and barriers to this training. Methods: The Council of Academic Family Medicine Educational Research Alliance (CERA) sent a survey in the fall of 2015 to all US family medicine residency program directors (PDs) containing questions about the status of GMV training for their residents. Results: The survey response rate was 53%. Fifty-nine percent of program director respondents report access to GMV and 61% note some form of training in this model of care. Seventy-nine percent of respondents indicate that GMV training is important for residents. Multiple barriers exist to optimizing GMV as part of current family medicine training. Conclusions: A majority of family medicine PD respondents report both access to and curriculum for GMV. While program directors endorse this practice model as an important element in resident training, they acknowledge challenges that may limit its availability. Opportunities to better understand and overcome barriers may increase programs’ capacity to deliver GMV skills.

scholarly journals AB0801 TIME FOR REFERRAL AND DEFINITIVE DIAGNOSIS IN PATIENTS WITH HAND ARTHRALGIA

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1425.1-1425
Author(s):  
P. Herrera-Sandate ◽  
G. Figueroa-Parra ◽  
D. Vega-Morales ◽  
J. A. Esquivel Valerio ◽  
B. R. Vázquez Fuentes ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Time Delay ◽  
Family Medicine ◽  
Tertiary Care ◽  
Definitive Diagnosis ◽  
Official Journal ◽  
Medical Visit ◽  
Medicine Clinic ◽  
Medical Visits ◽  
Medical Quality

Background:Early referral of patients with suspicion of progression to rheumatoid arthritis (RA) is of paramount importance in disease prognosis. We had previously described a time delay of 28 months between symptom onset and evaluation by a rheumatologist, and a mean wait time of 9.5 weeks for referral to a secondary-level public hospital (1). The availability of specialized interdisciplinary evaluation of patients in a third-level of care raises the possibility of shortening this time gap, as well as describing patient and physician decisions amidst the referral to a Rheumatology center.Objectives:Describe the diagnosis profile of patients with hand arthralgia and time of referral to Rheumatology in a Family Medicine clinic.Methods:A cohort study was conducted in 110 patients from October 2018 to December 2020 in a Family Medicine clinic within the tertiary-care University Hospital “Dr. Jose Eleuterio Gonzalez” in Monterrey, Mexico. Patients with hand arthralgia as their chief complaint were recruited. An observational, descriptive compilation of patient history was retrieved prospectively through medical records. Variables included time of inclusion, number of medical visits until referral and definitive diagnosis. Descriptive statistics, Kaplan-Meier curves and log-rank tests were used to test the association between time of diagnosis and clinical variables of interest.Results:Assessed variables are shown in Table 1. Out of 110 patients with hand arthralgia, a quarter received a final diagnosis within 3 medical visits. Less than half of patients were referred, and only a third attended the referral indication. It takes 39.3 days from the first medical visit to be referred, and 69 days and 2.89 consultations to receive a definitive diagnosis. Around half of patients will have a definitive diagnosis, osteoarthritis being the most common. The log-rank test for categoric variables including a positive squeeze test or ≥4 criteria of clinically suspect arthralgia did not show a significant association for time of referral and definitive diagnosis (data not shown).Table 1.Diagnostic and referral characteristics of patients with hand arthralgia attending a Family medicine clinicPatients recruited in a Family Medicine clinicn = 110Female, n (%)90 (81.8)Age in years, mean ± SD49.69 ± 14.90RF, ACPA, or hand radiography request, n (%)100 (90.9)Diagnosis in Family MedicineDiagnosed patients after 1 medical visit, cumulative n (%)5 (4.6)Diagnosed patients after 2 medical visits, cumulative n (%)22 (20.0)Diagnosed patients after 3 medical visits, cumulative n (%)26 (23.6)Referral to Rheumatology for diagnostic doubt or clinical follow-upPatients referred to a Rheumatology clinic, n (%)49 (44.5)Patients attending Rheumatology referral, n (%)34 (30.9)Time for referral, days ± SD39.37 ± 38.64Global definitive diagnosisPatients with a definitive diagnosis, n (%)51 (46.4)Osteoarthritis diagnosis, n (%)23 (20.9)Rheumatoid arthritis diagnosis, n (%)13 (11.8)Overlap syndrome diagnosis, n (%)5 (4.5)Time for definitive diagnosis, days ± SD68.96 ± 106.57Number of consultations for definitive diagnosis, mean ± SD2.86 ± 1.05RF, rheumatoid factor; ACPA, anticitrullinated protein antibodies; SD, standard deviation.Conclusion:Patients with hand arthralgia evaluated in a tertiary-care Rheumatology center receive a timely referral in one month and a definitive diagnosis after 3 medical visits in around two months.References:[1]Vega-Morales, D., Covarrubias-Castañeda, Y., Arana-Guajardo, A. C., & Esquivel-Valerio, J. A. (2016). Time Delay to Rheumatology Consultation: Rheumatoid Arthritis Diagnostic Concordance Between Primary Care Physician and Rheumatologist. American journal of medical quality: the official journal of the American College of Medical Quality, 31(6), 603.Graphs:Disclosure of Interests:None declared

scholarly journals 4063 Glycemic control in a weight management-focused group medical visits (WM/GMV) intervention: examining the moderating effects of body mass index (BMI)

2020 ◽  
Vol 4 (s1) ◽  
pp. 31-31
Author(s):  
Elizabeth Kobe ◽  
Cynthia J. Coffman ◽  
Amy S. Jeffreys ◽  
William S. Yancy ◽  
Jennifer Zervakis ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Weight Management ◽  
Glycemic Response ◽  
Targeted Interventions ◽  
Group Medical Visits ◽  
Low Carbohydrate Diet ◽  
Medical Visits ◽  
The Impact ◽  
Baseline Bmi

OBJECTIVES/GOALS: The impact of baseline BMI on glycemic response to group medical visits (GMV) and weight management (WM)-based interventions is unclear. Our objective is to determine how baseline BMI class impacts patient responses to GMV and interventions that combine WM/GMV. METHODS/STUDY POPULATION: We will perform a secondary analysis of Jump Start, a randomized, controlled trial that compared the effectiveness of a GMV-based low carbohydrate diet-focused WM program (WM/GMV) to traditional GMV-based medication management (GMV) on diabetes control. The primary and secondary outcomes will be change in hemoglobin A1c (HbA1c) and weight at 48 months, respectively. Study participants will be stratified into BMI categories defined by BMI 27-29.9kg/m2, 30.0-34.9kg/m2, 35.0-39.9kg/m2, and ≥40.0kg/m2. Hierarchical mixed models will be used to examine the differential impact of the WM/GMV intervention compared to GMV on changes in outcomes by BMI class category. RESULTS/ANTICIPATED RESULTS: Jump Start enrolled 263 overweight Veterans (BMI ≥ 27kg/m2) with type 2 diabetes. At baseline, mean BMI was 35.3 and mean HbA1c was 9.1. 14.5% were overweight (BMI 27–29.9) and 84.5% were obese (BMI ≥ 30). The proposed analyses are ongoing. We anticipate that patients in the higher BMI obesity classes will demonstrate greater reductions in HbA1c and weight with the WM/GMV intervention relative to traditional GMV. DISCUSSION/SIGNIFICANCE OF IMPACT: This work will advance the understanding of the relationship between BMI and glycemic response to targeted interventions, and may ultimately provide guidance for interventions for type 2 diabetes.

Abstract 15988: Heart Failure Group Medical Visits to Improve Quality of Life: A Feasibility Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Iniya Rajendran ◽  
Patricia Williams ◽  
Pei-Chun McGregor
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
High Risk ◽  
Medication Compliance ◽  
Exercise Stress ◽  
Retention Data ◽  
Group Medical Visits ◽  
Medical Visits ◽  
The Mean

Introduction: Group Medical Visits (GMV) are medical appointments where patients with similar medical conditions are seen in a group setting. Heart Failure (HF) is an ideal fit for the GMV model of healthcare delivery. HF guidelines emphasize the need for a self-care regimen including symptom knowledge, medication adherence, dietary and lifestyle modifications and social support. We conducted an intervention with these elements in a GMV setting to assess feasibility and improvement in quality of life (QoL). Methods: We enrolled a convenience sample of high-risk veterans with HF who required frequent follow up. Veterans participated in a longitudinal GMV for eight sessions lasting two hours each and occurring once a month. A curriculum was prepared a priori, and each session was led by an invited guest facilitator and focused on nutrition, exercise, stress, holistic health among others. Feasibility was assessed through recruitment and retention data. We also collected pre-post medication compliance data and QoL change using the 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ-12). We gathered feedback after each session. Results: Twelve patients were invited to the program and nine patients attended the first session. The average attendance was 6 participants each week with 4 participants attending all eight sessions. All were men, 22% identified as Black and 8 of 9 participants had preserved ejection fraction and obesity. At baseline, the mean KCCQ was 49.2. At the end of the intervention, the mean change in KCCQ-12 score was +9 (p=0.39). The largest change (+12, p=0.13) was seen on the QoL subscale. No significant improvement was seen in medication compliance. Participants listed community building, peer to peer education, learning about hospital services and continued contact with their provider as highlights of the program. Due to invitation of high-risk individuals, we had one death and seven hospitalizations during the study period. Conclusions: Longitudinal GMVs for high risk patients has a role in HF education and management. It may improve QoL and provider-patient relationship. It is well accepted by the veteran population and has the potential to be routinely integrated into clinical practice.

scholarly journals Group Medical Visits to Provide Gynecologic Care for Women Affected by Breast Cancer

2017 ◽  
Vol 4 (1) ◽  
pp. 18-23
Author(s):  
Sally R. Greenwald ◽  
Sarah Watson ◽  
Mindy Goldman ◽  
Tami S. Rowen
Keyword(s):  
Breast Cancer ◽  
Group Medical Visits ◽  
Medical Visits

scholarly journals Integrative Group Medical Visits: A National Scoping Survey of Safety-Net Clinics

Health Equity ◽  
2019 ◽  
Vol 3 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Ariana Thompson-Lastad ◽  
Paula Gardiner ◽  
Maria T. Chao
Keyword(s):  
Safety Net ◽  
Group Medical Visits ◽  
Medical Visits ◽  
Safety Net Clinics

scholarly journals Group Medical Visits and Clinician Wellbeing

2020 ◽  
Vol 9 ◽  
pp. 216495612097397
Author(s):  
Ariana Thompson-Lastad ◽  
Paula Gardiner
Keyword(s):  
Health Care ◽  
Care Delivery ◽  
Cost Savings ◽  
Models Of Care ◽  
Group Medical Visits ◽  
Integrative Health ◽  
Medical Visits ◽  
Integrative Health Care ◽  
Wide Range ◽  
Clinical Benefits

There is strong evidence for clinical benefits of group medical visits (GMVs) (also known as shared medical appointments) for prenatal care, diabetes, chronic pain, and a wide range of other conditions. GMVs can increase access to integrative care while providing additional benefits including increased clinician-patient contact time, cost savings, and support with prevention and self-management of chronic conditions. During the COVID-19 pandemic, many clinical sites are experimenting with new models of care delivery including virtual GMVs using telehealth. Little research has focused on which clinicians offer this type of care, how the GMV approach affects the ways they practice, and their job satisfaction. Workplace-based interventions have been shown to decrease burnout in individual physicians. We argue that more research is needed to understand if GMVs should be considered among these workplace-based interventions, given their potential benefits to clinician wellbeing. GMVs can benefit clinician wellbeing in multiple ways, including: (1) Extended time with patients; (2) Increased ability to provide team-based care; (3) Understanding patients’ social context and addressing social determinants of health. GMVs can be implemented in a variety of settings in many different ways depending on institutional context, patient needs and clinician preferences. We suggest that GMV programs with adequate institutional support may be beneficial for preventing burnout and improving retention among clinicians and health care teams more broadly, including in integrative health care. Just as group support benefits patients struggling with loneliness and social isolation, GMVs can help address these and other concerns in overwhelmed clinicians.

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