Group Medical Visits Research Articles

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

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.

Autonomy begets adherence: decisions to start and persist with osteoporosis treatment after group medical consultation.

Adherence and persistence with osteoporosis pharmacotherapy is low, possibly reflecting lack of confidence in physicians' treatment recommendations. We evaluated treatment decisions, decisional confidence, and 12-month treatment adherence among women who attended a group bone health consultation that fostered autonomous decision-making. We prospectively assessed postmenopausal women referred to an osteoporosis clinic who chose to attend a group medical visit in lieu of one-on-one consultation. The group visit was facilitated by a specialist physician and nurse, involving estimation of 10-year major osteoporotic fracture risk (using FRAX®) and extensive education regarding fracture consequences and potential advantages and disadvantages of pharmacotherapy. No direct advice was given by the specialist. Post-consult, participants made an autonomous decision regarding treatment intent and followed up with their family physician to enact their chosen plan. Intentions to initiate pharmacotherapy were assessed immediately post-consult. Treatment status and decisional confidence were evaluated 3 and 12 months later. Three-month treatment status was considered to reflect final treatment decision. Persistence was defined as proportion of participants on treatment at 3 months who remained treated at 12 months. One hundred one women (mean (SD) age, 62.7 years (5.8); median (IQR) FRAX®, 10.7% (8.3-17.6)) participated. Immediately post-consult, 27 (26.7%) intended to initiate treatment. At 3 months, 23 (22.8%) were treated, and at 12 months, 21 (91.3%) remained persistent. Of 89 questionnaire respondents at 12 months, 85 (95.5%) reported confidence in their treatment decision. When postmenopausal women are provided with individualized fracture risk estimates and enabled to make autonomous decisions regarding pharmacotherapy, ultimate decisions to receive treatment are made with confidence and result in high persistence at 12 months.

A Primary Care Response to COVID-19 for Patients with an Opioid Use Disorder.

A Primary Care Response to COVID-19 for Patients with an Opioid Use Disorder.

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

671-P: Recruitment and Retention of Minority Women for Women in Control 2.0: A Virtual Diabetes Self-Management Education Study

Background: Research is needed to improve diabetes care of minority women who are disproportionately affected by type 2 diabetes. Yet, barriers exist that hinder efforts to include minority women in research. Evidence suggests that successful study enrollment requires multiple recruitment strategies. Little is known about the correlation between recruitment strategy and retention. We aim to examine the relationship between Women in Control (WIC) recruitment strategies, enrollment rates, and retention. Methods: We utilized multiple strategies to recruit minority women, including culturally-tailored invitation letters and phone calls to targeted Boston Medical Center patients, referrals from clinicians and WIC participants, word of mouth, social media, and posted flyers. We analyzed WIC recruitment data to determine the proportion of participants recruited by each method. We then assessed the proportion of WIC participants who adhered to the Diabetes Self-Management Education (DSME) study protocol by recruitment method. Results: Overall, targeted recruitment methods (letters and phone calls) yielded the highest number of screens and enrollments with a total of 975 screened, 207 found eligible, 195 enrolled - with 75% of those enrolled, attending 5 out 8 DSME medical group visits (MGV). Recruitment flyers generated the second most potential participants with a total of 73 screened, 18 found eligible and enrolled - with 83% attending 5 out of 8 MGV. All other recruitment methods (clinician or participant referral, word of mouth, social media and unknown source) combined yielded a total of 85 screened, 23 found eligible, 23 enrolled - with 78% attending 5 out of 8 MGV. Conclusion: Although we used multiple methods to recruit minority women, our data shows that targeted recruitment - using culturally tailored messaging - was the most effective recruitment method. There was no relationship between recruitment method and retention in the intervention. Disclosure A. Bragg: None. P. Gardiner: None. S.B. Woods: None. J.M. Howard: None. S. Mitchell: Speaker’s Bureau; Self; Merck Sharp & Dohme Corp. Stock/Shareholder; Self; See Yourself Health, LLC. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R01DK106531)

659-P: Effect of Coaching en Diabetes (CoeD) Program on Glycemic Control in Steel Workers with Type 2 Diabetes

Patients with type 2 diabetes (T2D) could improve its glucose control with a multidisciplinary cultural management. Coaching en Diabetes (CoeD) is a multicomponent program for steel workers and their direct families with T2D when their A1C is >9% as an effort to increase attachment to medical treatment. The program focusses on the empowerment and glucose treatment sensibilization through a group medical visit, improvement of self-management and medical treatment. CoeD is performed by a multidisciplinary team (internist, nutritionist, diabetes educator, social worker, etc.). The aim of this study is to evaluate the effect of this program in glycemic control through 2 years of follow-up. This is a retrospective and longitudinal study of patients with uncontrolled T2D at Clinica Nova from Monterrey, Mexico. This study was conducted from May 2017 to 2019. We used descriptive statistics and ANOVA of repeated measures when it was appropriate. We included a total of 153 [115 (75.2%) males], with a mean (SD) age of 62.9 (11.2) years. The duration of T2D was 9.7 (6.6) years. During the follow-up 26 patients (17%) left the program, 2 of them died in relation to cardiovascular disease. All patients maintained a controlled blood pressure. We found a reduction of A1C of 1.5% [Mean (SD) 9.8% (1.5) to 8.3% (1.6), p=0.032) and fasting glucose of 41.8 mg/dl [Mean (SD) 180mg/dl (67) to 138.2mg/dl (55), p=0.021). These reductions were maintained through the 24 months of follow-up. The CoeD program was successful in reducing and sustaining A1C and pre-prandial glucose reduction in this group of patients. Disclosure M. Romero-Ibarguengoitia: None. O.M. Cantu Santos: None. D. Gutierrez Gonzalez: None. R. Gonzalez Facio: None. A. Gonzalez-Cantu: None.

1198-P: Hospital Use and Cost among Minority Women Enrolled in the Women in Control (WIC) Virtual World Diabetes Self-Management Education (DSME) Comparative Effectiveness Trial

Background: DSME improves diabetes outcomes, however participation is low. Virtual world (VW) technology is a scalable and engaging platform for DSME. The WIC study compared the effectiveness of DSME Medical Group Visits conducted in a VW platform vs. in-person to improve diabetes outcomes for minority women with uncontrolled type 2 diabetes (T2DM). Objective: To assess the impact of WIC DSME intervention on hospital use and associated costs (inpatient, observation stays, ED visits). Methods: Hospital utilization and billing data of the WIC-DSME intervention was analyzed 6-months pre-to-post enrollment for the study cohort and by study arm for a subset of 142 minority women with T2DM who completed the study. The percent change in the number of hospital utilizations from pre-to-post enrollment was calculated and associated costs were estimated from billing data and compared by study arm, utilization type and for the cohort as a whole. Results: Total utilization among all 142 WIC program completers decreased by 25% from 114 events (57 events per arm) in the 6-months prior to WIC enrollment to 86 events (n=38 in-person; n=48 VW) in the 6-months post-enrollment. Hospital charges also decreased from $767,730 to $601,446 (22%). Among VW DSME participants, there was a 16% reduction in total utilization compared to a 33% reduction in the in-person DSME arm. Among VW participants, there was a 46% decrease in the number of high cost utilizations (observations and inpatient) and a 36% decrease in Emergency Department (ED) visits post-enrollment. Among in-person participants, there was no change in total high cost utilizations and a 68% decrease in ED visits. Total hospital charges for the WIC in-person DSME arm decreased by $24,625 (-6%) and $141,659 (-37%) for the WIC virtual world arm. Conclusion: Both in-person and VW DSME are associated with lower hospital utilization and costs among minority women with uncontrolled T2DM. Disclosure S. Mitchell: Speaker’s Bureau; Self; Merck Sharp & Dohme Corp. Stock/Shareholder; Self; See Yourself Health, LLC. A. Bragg: None. J.M. Howard: None. P. Gardiner: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R01DK106531)

A crack in the wall: Chronic pain management in integrative group medical visits

Amidst a national crisis of opioid overdose, substantial uncertainty remains over how to safely and effectively address chronic pain. In response to this crisis, safety-net primary care clinics are instituting integrative group medical visits (IGMVs) for chronic pain management. Through two qualitative studies of IGMVs, we found that these groups acted as workarounds implemented by clinicians seeking to innovate upon standard pain management protocols. While clinical uncertainty is often framed as a problem to be managed, in this instance, overlapping uncertainties provided an opportunity through which enterprising clinicians could generate reform at the local level. However, these clinician-led changes were incremental, situational, and partial, and occurred outside of broader systemic reform. In the following article, we draw on 46 interviews with clinicians and staff associated with IGMVs and observations of 34 sessions of 22 distinct IGMVs. We begin by describing the structure of the IGMVs we observed. We analyze the multiple uncertainties surrounding chronic pain and its treatment at the time of our data collection, just before the opioid crisis was declared a national public health emergency. We then demonstrate how clinicians tinkered with existing pain management protocols via their involvement with IGMVs. Lastly, we discuss the conditions of possibility that allowed for the existence of IGMVs at our study sites, as well as the conditions of limitation that restricted the expansion of these groups. Our research points to the potential of IGMVs for treating chronic pain, while showing that IGMVs continue as an innovation by individual clinicians, not as a result of broader reforms.

Human-centered design as a guide to intervention planning for non-communicable diseases: the BIGPIC study from Western Kenya

BackgroundNon-communicable disease (NCD) care in Sub-Saharan Africa is challenging due to barriers including poverty and insufficient health system resources. Local culture and context can impact the success of interventions and should be integrated early in intervention design. Human-centered design (HCD) is a methodology that can be used to engage stakeholders in intervention design and evaluation to tailor-make interventions to meet their specific needs.MethodsWe created a Design Team of health professionals, patients, microfinance officers, community health workers, and village leaders. Over 6 weeks, the Design Team utilized a four-step approach of synthesis, idea generation, prototyping, and creation to develop an integrated microfinance-group medical visit model for NCD. We tested the intervention with a 6-month pilot and conducted a feasibility evaluation using focus group discussions with pilot participants and community members.ResultsUsing human-centered design methodology, we designed a model for NCD delivery that consisted of microfinance coupled with monthly group medical visits led by a community health educator and a rural clinician. Benefits of the intervention included medication availability, financial resources, peer support, and reduced caregiver burden. Critical concerns elicited through iterative feedback informed subsequent modifications that resulted in an intervention model tailored to the local context.ConclusionsContextualized interventions are important in settings with multiple barriers to care. We demonstrate the use of HCD to guide the development and evaluation of an innovative care delivery model for NCDs in rural Kenya. HCD can be used as a framework to engage local stakeholders to optimize intervention design and implementation. This approach can facilitate the development of contextually relevant interventions in other low-resource settings.Trial registrationClinicaltrials.gov, NCT02501746, registration date: July 17, 2015.

Using a group medical visit model to promote healthy behaviour change with an underserved population.

Models of care are needed to address physical activity, nutrition promotion and weight loss in primary care settings, especially with underserved populations who are disproportionately affected by chronic illness. Group medical visits (GMVs) are one approach that can help overcome some of the barriers to behaviour change in underserved populations, including the amount of time required to care for these patients due to socio-economic stressors and psychosocial complexities (1). GMVs have been shown to improve care in coronary artery disease and diabetes, but more evidence is needed in underserved settings. This project sought to evaluate a GMV incorporating a physical activity component in an underserved patient population, measuring biometric and motivation outcome measures. This project used a pre-post intervention study design through patient surveys at baseline and 12 weeks. We included validated motivational measures along with self-reported demographic information. A GMV intervention promoting physical activity and nutrition to promote weight loss was delivered by an interdisciplinary primary care team and community partners in a Federally Qualified Health Center in Rochester, NY. The intervention consisted of six, 2-hour sessions that occurred every other week at the clinic site. Participants lost a significant amount of weight and maintained the weight loss at 6 months. In addition, there was a significant improvement in motivation measures. This study provides preliminary evidence that our GMV model can improve weight loss and autonomous motivation in an underserved population. This project has potential for scalability and sustainability.

Applying a Medical Wellness Group Visit Model to a Community Setting Yielding Weight Loss and Improved Laboratory Results.

To determine the feasibility of applying a medical wellness group (WG) model to a community setting to improve cardiometabolic health. This quasi-experiment was designed to compare individuals participating in the WG to participants in the control group who received general lectures on nutrition, physical activity, and sleep. A suburb north of Boston, Massachusetts. Forty-five adults were in the WG and 10 in the control group. Fourteen weekly 90-minute sessions, led by a physician and dietitian, focusing on nutrition, physical activity, and sleep, compared to controls receiving two 30-minute general wellness lectures provided within 3 months. Pre- and postweight, waist circumference, hemoglobin A1C (HbA1c), and serum lipids; a survey measuring beliefs, attitudes, and intentions related to behavioral change. T tests examined the mean change in biometric measurements. The Wilcoxon test was used to compare the ordinal questions in baseline and final survey results. The Mann-Whitney test was used to compare final survey results between groups. The WG demonstrated desirable difference-in-difference between groups in weight (P < .001), waist circumference (P < .001), and total cholesterol (P = .03) compared to the control group. Mean change of HbA1c and triglycerides was not different between groups. Survey results showed that attitudes, perceived behavioral control, and feeling supported about wellness behaviors significantly improved from baseline to final visit in the WG (P = .002; P = .019, P = .006, respectively), but not among controls. Wellness groups are feasible and provide high levels of support and accountability that empower people to make behavioral changes to improve health.

The Quadruple Aim as a Framework for Integrative Group Medical Visits.

Integrative group medical visits (IGMVs) are a compelling health service delivery innovation, which create an opportunity to expand access to complementary and integrative health care (CIH). IGMVs add CIH to existing group medical visit (GMV) models, in response to CIH's inaccessibility to many people due to limited insurance coverage and high out-of-pocket costs. Although IGMV programs and GMVs more broadly vary in structure, duration, frequency, and staffing, researchers and practitioners have identified benefits to patients, health care staff, and organizations that are present across IGMV models. Having identified a need for a framework to support IGMV implementation and research, the authors propose the Quadruple Aim Framework. Researchers suggest that GMVs can meet the goals of the Quadruple Aim by (1) improving patient experience through extended time with the clinician, peer support, and engagement in care; (2) improving population health through better patient health outcomes; (3) lowering health care costs, as demonstrated in studies of GMV cost-effectiveness; and (4) improving practitioner experience described in qualitative research with GMV practitioners. The authors recommend that the Quadruple Aim be used as a framework to guide the future of both group-delivered services and research, to measure the potential impact of these programs on advancing health equity. Eventually, they hope that innovations such as these will lead to widespread uptake and sustainment of CIH interventions across the socioeconomic spectrum.

Group Medical Visits: experiences with patient and resident implementation

ABSTRACTObjective: Patients with diabetes must navigate multiple components of care to self-manage their disease. Group Medical Visits (GMVs) are a forum for patients to see a provider as well as actively participate in education and care management with other patients with diabetes. The objective is to describe GMV implementation and resident involvement in a primary care setting.Methods: We adapted and implemented a GMV model into a primary care practice with a residency program. Residents attend GMV sessions that provide a continuity experience in addition to their regular clinic schedules. A cohort of patients enroll in a series of eight GMVs occurring over of 4 months. Each patient and resident complete surveys evaluating the visits.Results: There have been 14 GMV groups totaling 70 participants. GMV groups (N = 67) mean A1C for reduction was 0.53 ± 1.60 from baseline to 3- to 6-month post-GMV follow-up. Resident and patient feedback show an overall positive experience.Conclusion: The GMV model offers patients the setting to interact and exchange experiences with each other as well as to receive feedback from providers and the health-care team. The incorporation of the GMV program into residency training provides a continuity group care experience and an alternative practice model.

Group Medical Visits and Clinician Wellbeing

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.

Comparison of Group Medical Visits Combined With Intensive Weight Management vs Group Medical Visits Alone for Glycemia in Patients With Type 2 Diabetes

Traditionally, group medical visits (GMVs) for persons with diabetes improved glycemia by intensifying medications, which infrequently led to weight loss. Incorporating GMVs with intensive dietary change could enable weight loss and improve glycemia while decreasing medication intensity. To examine whether a program of GMVs combined with intensive weight management (WM) is noninferior to GMVs alone for change in glycated hemoglobin (HbA1c) level at 48 weeks (prespecified margin of 0.5%) and superior to GMVs alone for hypoglycemic events, diabetes medication intensity, and weight loss. This randomized clinical trial identified via the electronic medical record 2814 outpatients with type 2 diabetes, uncontrolled HbA1c, and body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 27 or higher from Veterans Affairs Medical Center clinics in Durham and Greenville, North Carolina. Between January 12, 2015, and May 30, 2017, 263 outpatients started the intervention. Participants randomized to the GMV group (n = 136) received counseling about diabetes-related topics with medication optimization every 4 weeks for 16 weeks, then every 8 weeks (9 visits). Participants randomized to the WM/GMV group (n = 127) received low-carbohydrate diet counseling with baseline medication reduction and subsequent medication optimization every 2 weeks for 16 weeks followed by an abbreviated GMV intervention every 8 weeks (13 visits). Outcomes included HbA1c level, hypoglycemic events, diabetes medication effect score, and weight at 48 weeks analyzed using hierarchical generalized mixed models to account for clustering within group sessions. Among 263 participants (mean [SD] age, 60.7 [8.2] years; 235 [89.4%] men; 143 [54.4%] black), baseline HbA1c level was 9.1% (1.3%) and BMI was 35.3 (5.1). At 48 weeks, HbA1c level was improved in both study arms (8.2% in the WM/GMV arm and 8.3% in the GMV arm; mean difference, -0.1%; 95% CI, -0.5% to 0.2%; upper 95% CI, <0.5% threshold; P = .44). The WM/GMV arm had lower diabetes medication use (mean difference in medication effect score, -0.5; 95% CI, -0.6 to -0.3; P < .001) and greater weight loss (mean difference, -3.7 kg; 95% CI, -5.5 to -1.9 kg; P < .001) than did the GMV arm at 48 weeks and approximately 50% fewer hypoglycemic events (incidence rate ratio, 0.49; 95% CI, 0.27 to 0.71; P < .001) during the 48-week period. In GMVs for diabetes, addition of WM using a low-carbohydrate diet was noninferior for lowering HbA1c levels compared with conventional medication management and showed advantages in other clinically important outcomes. ClinicalTrials.gov identifier: NCT01973972.

Veteran and learner outcomes of interprofessional trainee-led group medical visits

Abstract Background Patient-centered primary care models encourage alternative methods of care delivery, including group medical visits (GMV). The Boise VA Medical Center conducted trainee-led GMV for patients with diabetes from 2013 to 2017. Purpose Patient-Aligned Care Teams in VA include implementation of GMV. Our aim was to address gaps in diabetes care while offering a novel clinical learning experience for interprofessional trainees. Methods Evaluation of patient and trainee participants in GMV from 2015 to 2017 was conducted. Patient data included HgA1c, systolic blood pressure, weight, and LDL cholesterol measurements. The Interprofessional Socialization and Valuing Scale (ISVS) assessed trainee attitudes about collaborative practice. Discussion Analysis of patient data showed improvements in HgA1c. Trainees demonstrated improved value, ability and comfort working with others. Conclusions GMV was associated with positive clinical outcomes in patients with diabetes. Participation in GMV during training may improve trainees’ collaborative attitudes and prepare them to plan, lead and execute GMVs in their future practice.

Group Medical Visits 2.0: The Open Source Wellness Behavioral Pharmacy Model.

Objectives: The Open Source Wellness (OSW) model was designed to function as a behavioral pharmacy; an affordable, accessible delivery system for a universal experiential prescription: MOVE (physical activity), NOURISH (healthy meals), CONNECT (social support), and BE (stress reduction). This study evaluates the OSW model in a billable group medical visit (GMV) format in a federally qualified health center (FQHC). Intervention: Patients with behaviorally mediated conditions, including cardiovascular disease, diabetes, and depression, as well as poor social determinants of health, such as food insecurity, were prescribed participation in the OSW program by their medical team. Groups met for 2 h each week for 16 weeks to complete 30 min of socially engaging physical activity, 5 min of mindfulness meditation, a 10-min interactive, didactic health lesson, a 5-min nutrition lesson, and 60 min of small-group coaching over a plant-based meal. Paraprofessional health coaches worked with participants in small groups to provide support and create accountability to goals. In addition, participants received a $10 voucher to Food Farmacy, which provided free produce. Subjects: The sample consisted of 49 patients from the Hayward Wellness Center, an FQHC in Hayward, California. They were mostly women, 59.6%, and racially and ethnically diverse: 23.1% African American, 5.8% Asian, 26.9% Hispanic/Latino, 11.5% Pacific Islander, and 32.7% Caucasian. Participants averaged 59.1 years of age (SD = 10.6). Outcome measures: Blood pressure and weight were recorded weekly. Demographic and acute care utilization data were drawn from the electronic medical record. Self-report questionnaires assessed diet, exercise, and mood on a monthly basis. Methods and results: Longitudinal data were analyzed with linear mixed models. Participants (n = 49) demonstrated significant increases in daily servings of fruits and vegetables, b = 0.31, p < 0.01, and exercise, b = 11.50, p < 0.01, as well as significant reductions in body mass index, b = -0.10, p = 0.05. Acute care utilization decrease was not statistically significant, b = -0.07, p = 0.14. Depressed patients (n = 11) saw reductions in depression, b = -1.72, p < 0.01, and hypertensive patients (n = 24) saw reductions in systolic blood pressure, b = -4.04, p < 0.01, but not diastolic blood pressure, b = 0.04, p = 0.95. Conclusions: This study demonstrates the effectiveness of the OSW behavioral pharmacy model within a GMV context; pathways for adaptation, spread/scale, and incorporation of this work as a component of the broader health ecosystem and national commitment to health equity are discussed.

Process evaluation of team-based care in people aged >65 years with type 2 diabetes mellitus

ObjectiveThe prevalence of type 2 diabetes mellitus (T2DM) is increasing globally and there is critical need develop interventions to improve health outcomes among older people. The Group Appointments in Primary...

Improving Access to Integrative Oncology Through Group Medical Visits: A Pilot Implementation Project.

Objectives: This article describes the implementation of a group medical visit (GMV) model to increase access to integrative oncology (IO) care. The most challenging and critical time to access high-quality IO care is while patients are receiving conventional cancer therapy. Often demand for individual IO clinic consultations precludes this from occurring. A three-session GMV program was designed to alleviate barriers to receiving integrative care during active cancer treatment. Design: A consolidated framework was used for implementation research and focused ethnography methods to describe the IO GMV implementation process. Data sources included patient evaluations, participant observation, and brief provider and patient interviews. Setting: A pilot program was created to assess the feasibility and acceptability of implementing IO GMVs at a comprehensive cancer center. Intervention: Each three-session GMV consisted of a didactic session, followed by individual visits with the integrative oncologist. Results: The setting, intervention, and implementation process of the IO GMV program were described. Thirty-two patients participated in the first five cohorts of the program. Twenty-two were women; 24 were White. The median age of participants was 52. Patient evaluations demonstrate high levels of satisfaction with the program with all scored aspects rated >4.0 on a five-point Likert scale. For the medical center, group visits are a financially viable alternative to individual IO visits; revenue from group visits exceeded the revenue potential of 6 h of individual visits by an average of 38%. Conclusion: GMVs are a feasible and promising model for increasing access to IO. Patients in active cancer treatment were able to participate in the program. Future research and implementation efforts could examine health outcomes over time after participation in GMVs, as well as the feasibility of using this model with more diverse patient populations.

Feasibility and Acceptability of Mindfulness-Based Group Visits for Smoking Cessation in Low-Socioeconomic Status and Minority Smokers with Cancer.

Objective: Smoking cessation studies tailored for low-income and racial/ethnic minority cancer patients are limited. African American and low-socioeconomic status (SES) smokers have higher cancer mortality rates and are less likely to use evidence-based smoking cessation treatments compared with white and higher SES counterparts. Mindfulness training is a promising approach to address racial and SES disparities in smoking cessation. The authors assessed the feasibility and acceptability of a mindfulness-based smoking cessation (MBSC) medical group visit for low-income and racially diverse smokers with cancer. Design and intervention: The authors adapted the integrative medical group visit model used for chronic pain and included the You Can Quit smoking cessation curriculum used at the study site, Tobacco Treatment Center. The program was conducted in eight weekly 2-h visits. The authors then tested the feasibility and acceptability of this intervention for actively smoking cancer patients and cancer survivors in two pilot groups (N = 18) using a pre-post design. Setting/Location: This study took place at Boston Medical Center, a large urban safety net academic teaching hospital. Outcome measures: The authors used a medical group visit intake form to collect data on weekly cigarette intake and home practice. They also gathered additional qualitative data from focus groups and in-depth interviews. Results: Over 50% of participants (n = 10) self-identified as black and 56% reported an annual income of $20,000 or less. Over two-thirds of the participants attended four or more of the eight group visits. There was a significant decrease in weekly cigarette intake from 75.1 cigarettes at baseline to 44.3 at 3 months (p = 0.039). None of the participants quit smoking. Participants were satisfied with the program and reported positive lifestyle changes. Conclusion: MBSC group visits are feasible and acceptable among racially diverse and low-SES smokers with cancer and should be further studied in a larger cohort.