• Group medical visits are one-to-one medical appointments in a group setting
• Self management empowers patients to become partners in their care
• Health literacy is about ensuring patients understand basic health information
Introduction
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Practice Reflection
• Have you ever organized a group medical visit to deliver individual care to multiple patients at once?
• Have you introduced patient self-management strategies into your practice?
• Have you considered the Literacy of your patient?• Have you made any changes based on your
practice self assessment?
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GPSC and PSP
• GPSC – Who, What, Why
• Practice Support Program (PSP) Who, What, Why Reimbursement Accreditation – Main Pro C, Main Pro M1
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http://www.youtube.com/watch?v=Fi9nTCZoRfA
Fresh Ideas Video
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• Increase patient doctor relationship
• Improve access• Efficient way to meet
clinical guidelines• Greater attention to
psychosocial • Support other patients• Decrease patient phone
calls
• Improve patient self management
• Improve patients understanding of their health issues
• Improve patient satisfaction
• Improve provider satisfaction
• Improve cost
Group Medical Visit Benefits
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Literature – Dr. Ed Noffsinger
• 200%-311% ↑ in MD productivity• 92% ↑ in pt satisfaction • 87% of patients returned to groups for their care• Up to 73% ↓ in wait times
(Noffsinger E, Various studies)
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The Power of Group Medical VisitA REAL, local example from Masset, BC
Significant improvement in completion and target ratesMeasures Massett
Clinic’s Goal All BC (data) Masett Clinic
Data (1:1 visits)
Masett Clinic Data (GMV)
A1c < 7.0 85% 45% 58% 75%
B/P < 130/80 60% 47% 53% 62.5%
Annual LDL < 2.5 70% 34% 38% 60%
Annual ACR < 2.0M < 2.8F
85% 32% 44% 50%
Annual foot exam 90% 36% 83% 100%
Annual documented self management goal
85% 34% 74% 100%
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Why a group medical visit instead of 1:1?Physician Quote:
Dr. Becky Temple
“Since starting group medical appointments for my depressed and anxious patients I have felt much more satisfied with the care I am providing....allowing me to share CBT exercises, and medication information in a much more detailed manner to several patients at one time; patients find it valuable to discover that they are not alone in their struggles with symptoms and to hear about how others have successfully managed their illness with medications and other therapies....much more powerful than me saying so as a physician"
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Patient Quote:
Brian
“Group medical visits, I think everyone should attend at least one and let them be the judge. Most of my doctors appointments are group medical appointments”.
“Questions that I would have liked to have asked but didn’t have the courage to, someone else asked and I learned from that. Questions that I didn’t even think to ask were asked and I learned even more”.
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Group Visit Models
Model 1:
Cooperative Health Care Clinic (CHCC)
Model 2:
Drop-in Group Medical Appointments (DIGMAs)
Model 3:
Physicals Shared Medical Appointments (SMAs)
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Common Features of All Group Medical Visit Models:- These are 1:1 medical appointments that happen in a
group setting (i.e. assessment, diagnosis, prescription renewal, review of labs)
- Reduce repetition and duplication- In all cases patients will be asked to sign patient
confidentiality forms- All physicians and patients will fill out an evaluation form- Groups medical appointments will begin on time and end
on time- Patients have 90 minutes with their physician
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Cooperative Health Care Clinic (CHCC) Model
Key Concepts: Pre-book 10-15 high-utilizer patients Book the same people in the same group on a
regular basis e.g., monthly/quarterly 90 - 120 minutes in duration Consist of individual 1:1 with doctor done in a
group Review of test result Question & answer period Topic for education (30 mins.) based on group decision
Limited private consultation with doctor after the group
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Drop In Group Medical Appointment (DIGMA)
Key Concepts: 80% pre-booked Can be booked from a patient registry for recall Can be Homogeneous group (single issue) Can be Heterogeneous group (various
conditions) 12 – 16 patients see their doctor 1:1 in a group
dynamic Education is opportunistic with each patient
interaction
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Shared Medical Appointments (SMAs)
Key Concepts: Pre-booked (80%) Shared physicals appointment (ideal for
prenatal, baby-wellness, women’s and men’s health needs, or cardiovascular follow up appointments)
8-12 (max) patients First half of the session is a private physical
exam by doctor, while other group members are sharing & learning with behaviourist
Second half is doctor patient interactions in a group
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Physician Role
• Physician will begin and end appointments on time• Have a face-to-face appointment done in a group setting• Patients that need to be seen privately can do so at the
end• Share patient clinical data• Chart during the group meeting
Order lab tests Prescriptions Document patient self management plan
• Participate in short debriefing at the end of GMV
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Behaviourist Role
Arrives 15-20 mins early – takes BP, weight, etc Welcomes patients by asking each to identify their
main concern (writes them on flip chart) Manages group dynamics Promotes meaningful group discussion while GP is
doing chart note Addresses confidentiality Collects evaluations Begins group on time, and ends on time Participates in short debriefing at the end of GMV
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MOA or Office Staff Role
• Prepares for Group Medical Visit: Organizes the group space Overbooks by 25% (stats show 81% of pre-registered
actually show up) Telephone or mail or email invitation letter
• Makes a patient information package including confidentiality and evaluation forms, patient self management action plans, most recent flow sheets, etc.
• As patients arrive assist with BP, weight, foot exam, etc and document
• Track data/narrative reports/measures • Participates in short debriefing at the end of
GMV
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Coordinator Role
• Encourages role maximizing, and facilitates role expansion and any additional training
• Finds a suitable behaviourist match (requires doctor/MOA input)
• Attends GMV’s until independent (as needed)• Facilitates team debrief after GMV (as needed)• Troubleshoots issues (i.e. where to hold the
GMV)• Continues to keep in touch for support (the whole
practice team)
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