Abstract
BackgroundShared medical appointments (SMAs), or group visits, are a healthcare delivery method with the potential to improve chronic disease management and preventive care. In this review, we sought to better understand opportunities, barriers, and limitations to SMAs based on patient experience in the primary care context.MethodsAn experienced biomedical librarian conducted literature searches of PubMed, Cochrane Library, PsycINFO, CINAHL, Web of Science, ClinicalTrials.gov, and SSRN for peer-reviewed publications published 1997 or after. We searched grey literature, nonempirical reports, social science publications, and citations from published systematic reviews. The search yielded 1359 papers, including qualitative, quantitative, and mixed method studies. Categorization of the extracted data informed a thematic synthesis. We did not perform a formal meta-analysis.ResultsScreening and quality assessment yielded 13 quantitative controlled trials, 11 qualitative papers, and two mixed methods studies that met inclusion criteria. We identified three consistent models of care: cooperative health care clinic (five articles), shared medical appointment / group visit (10 articles) and group prenatal care / CenteringPregnancy® (11 articles).ConclusionsSMAs in a variety of formats are increasingly employed in primary care settings, with no singular gold standard. Accepting and implementing this nontraditional approach by both patients and clinicians can yield measurable improvements in patient trust, patient perception of quality of care and quality of life, and relevant biophysical measurements of clinical parameters. Further refinement of this healthcare delivery model will be best driven by standardizing measures of patient satisfaction and clinical outcomes.
Highlights
Shared medical appointments (SMAs), or group visits, are a healthcare delivery method with the potential to improve chronic disease management and preventive care
Shared medical appointments (SMAs), or group visits, are a healthcare delivery innovation arising from the changing demands of patient-centered medical home (PCMH) settings and the primary care context
This review aims to meet this need by examining the patient experience from the published literature alongside an assessment of SMAs to improve biophysical outcomes in the adult primary care setting
Summary
Shared medical appointments (SMAs), or group visits, are a healthcare delivery method with the potential to improve chronic disease management and preventive care. Multiple standardized SMA delivery models have been established, from the drop-in group medical appointment, cooperative health care clinic (CHCC) and physicals shared medical appointment, to CenteringPregnancy® (CP) and parenting visits [3, 6]. These visits frequently emphasize the “coproduction” roles of patients as experts in their own circumstances and health professionals as facilitators rather than fixers, fostering a shared experience of illness and health to better inform, empower, and support [2]. The various interpretations of the group clinical model have been applied to a wide array of settings and a myriad of health promotion and disease-focused visits, including patients with diabetes, hypertension, congestive heart failure, chronic lung disease, asthma, arthritis, stroke, kidney disease, cancer, hearing impairment, and prenatal care, among other conditions [7,8,9,10,11,12,13,14,15]
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