Group visits

Group visits are also known as shared medical appointments, structured medical appointments or planned medical appointments.

SMAs are a series of consecutive individual medical consultations in a supportive group setting where all can listen, interact, and learn. SMAs are also called group visits and are an evolving way of managing chronic disease in primary care. An SMA is both an individual consultation and an informal group education session.

Video: Shared Medical Appointments in Australia

(Australian Musckulo-skeletal Network, Australia, 2014)

• Group exposure in SMAs combats isolation, which in turn helps to remove doubts about one’s ability to manage illness.
• Patients learn about disease self-management vicariously by witnessing others’ illness experiences.
• Patients feel inspired by seeing others who are coping well.
• Group dynamics lead patients and providers to developing more equitable relationships.
• Providers feel increased appreciation and rapport toward colleagues, leading to increased efficiency.
• Providers learn from the patients how better to meet their patients’ needs.
• Adequate time allotment of the SMA leads patients to feel supported.
• Patients receive professional expertise from the provider in combination with first-hand information from peers, resulting in more robust health knowledge.
• Patients have the opportunity to see how the physicians interact with fellow patients, which allows them to get to know the physician and better determine their level of trust.

There are two main types of SMAs: drop-in group medical appointments (DIGMAs) and programmed shared medical appointments (PSMAs).

DIGMAs can involve heterogenous groups with a range of standard medical problems. They are conducted at a standard time each week to reduce waiting time and enable acute care more accessible.

PSMAs are a sequence of SMAs in a semi-structured form providing educational input relating to a specific topic. A good example is a diabetes-focused group, which allows patients with diabetes to come together regularly to listen, interact and learn from each other and provides a good opportunity for a facilitator with extra training in diabetes to educate through a lecture or discussion format.

SMAs could comprise 6–12 patients at a time and typically include a doctor and a facilitator, who is usually an allied health professional. The facilitator is the one who manages group dynamics and directs the 60–90 minute sessions. SMAs are suitable for you and your patients if you are frustrated with the limitations of 1:1 consulting.

Video: How to Run a Group Medical Visit

(Accelerating Change Transformation Team - Alberta Health Services, Canada, 2015)

Why are doctors not routinely implementing SMAs to treat physical and mental conditions given the benefits of group interventions? There are four crucial components that are missing:

1. Rigorous scientific evidence supporting the value of shared appointments.
2. Easy ways to pilot and refine shared-appointment models before applying them in particular care settings.
3. Regulatory changes or incentives that support the use of such models.
4. Relevant patient and clinician education

These are necessary for any highly innovative service-delivery model including SMAs to become standard. 

Information on group visits literature for healthcare providers.

• Omogbai T, Milner KA. Implementation and evaluation of shared medical appointments in veterans with diabetes: A quality improvement study. J Nurs Adm. 2018 Mar;48(3):154-159 [Abstract](external link) 
• Egger G, Stevens J, et al. Programmed shared medical appointments: A novel procedure for chronic disease management. (external link)Aust J Gen Pract. 2018 Jan-Feb;47(1-2):70-75. [full article](external link)
• Kirsh SR, Aron DC, et al. A realist review of shared medical appointments: How, for whom, and under what circumstances do they work? BMC Health Serv Res. 2017 Feb 4;17(1):113. [full article](external link)
• Menon K, Mousa A, de Courten MP, Soldatos G, Egger G, de Courten B Shared medical appointments may be effective for improving clinical and behavioral outcomes in type 2 diabetes – a narrative review(external link)Front. Endocrinol. 2017. 8:263. [Full article](external link) 
• 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.(external link) J Am Osteopath Assoc. 2016 Dec 1;116(12):780-787.
• Housden LM, Wong ST. Using group medical visits with those who have diabetes – examining the evidence. Current Diabetes Reports. 2016;16(12):134. [Abstract](external link)
  Edelman D, Gierisch JM, McDuffie JR, Oddone E, Williams Jr JW. Shared medical appointments for patients with diabetes mellitus – a systematic review.(external link) Journal of General Internal Medicine. 2015;30(1):99-106.
• Noffsinger EB. The ABCs of group visits: An implementation manual for your practice. New York: Springer-Verlag New York. 2013.
• Suzanne H. Eisenstat S, Lipps Siegel A, Carlson K, et al. Putting group visits into practice(external link) John D. Stoeckle Center for Primary Care Innovation, Massachusetts General Hospital. 2012
• Noffsinger EB. Running group visits in your practice. New York: Springer-Verlag New York. 2009.
• Noffsinger EB. Use of group visits in the treatment of the chronically ill. In Chronic Disease Management. Nuovo J (Ed.) New York: Springer-Verlag New York. 2007
• Bronson D, Maxwell R. Shared medical appointments: Increasing patient access without increasing physician hours. Cleveland Clinic Jour Med 2004;71(5):369-377.
• Houck, S. Kilo, C. Scott, JC. Group visits 101(external link) Fam Pract Manag. 2003 May;10(5):66-68.