Sharing Medical Appointments

For the past three and a half years, Harvard Vanguard Medical Associates – a multi-specialty group practice in Boston – has been offering patients the opportunity to participate in what are called “shared medical appointments.” 

Photo courtesy of Harvard Vanguard Medical Associates

                                                                                                           

Unlike traditional physician visits, 8-12 patients with similar medical needs are seen as a group by a multi-disciplinary team of caregivers, including their physician, a nurse or medical assistant who takes vital signs and updates immunizations and screenings, a facilitator who addresses psychosocial issues and acts as a patient advocate, and a scribe who enters information into patients’ medical records in real time.

Instead of the typical 15-minute physician visit, patients have 90 minutes with their doctor and care team and also benefit from hearing the questions and concerns of other patients. All of the patients (and any family members who accompany them) are required to sign a confidentiality agreement, and the visit is billed as a typical office visit with the usual co-pay. Individual physical exams are conducted in a private exam room, while others in the group continue to ask questions and discuss their common concerns.

According to Dr. Zeev Neuwirth, chief of clinical effectiveness and innovation at Harvard Vanguard, 80-90% of patients who try group visits are interested in repeating them. And while patient satisfaction scores are no different for group visits than they are for individual visits, Harvard Vanguard has noticed that patients who participate in group visits are more likely to say that their doctors know them as people and are more sensitive to their needs.  “We believe it is more compassionate care,” says Neuwirth.

To encourage more providers to try shared medical appointments, Harvard Vanguard is sponsoring a symposium November 3-4 in Cambridge, Massachusetts.  Clinicians from Cleveland Clinic, which has offered group visits since 2002, and Kaiser Permanente, also an early adopter, are among those who will share their experiences and outcomes. 

With the current pressures on primary care, shared medical appointments may be just what the doctor ordered for certain kinds of patients. According to a recent Wall Street Journal article, group visits have been particularly well received by older patients with chronic conditions, who have the time to participate in these longer visits and benefit from the additional support and socialization they receive.  They may be less feasible for younger people juggling busy work and family schedules. 

According to a survey conducted last year by the American Academy of Family Physicians, 8.4% of doctors offered shared appointments, up from 5.7% in 2005.

This new model of care would appear to require an even greater emphasis on excellent communication and teamwork on the part of caregivers to ensure that patients’ medical, emotional, and psychosocial needs are met.  Shared medical appointments can be conducted in a compassionate and patient-centered way, but they aren’t inherently so.  There are ample opportunities to provide compassionate care, but as in more traditional models, caregivers and patients have to be prepared and ready to take advantage of them.

Have you participated in shared medical appointments? Would you recommend them to others? Have they improved your relationship with your doctor and other caregivers?