Group Visits

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WHY GROUP VISITS?

• Patients like them
• Physicians and their staff enjoy them
• They are cost effective and increase access to
  quality health care
• Patient outcomes have been shown to be better.
• - reduction in emergency room visits
• - reduction in hospitalization
• -decreased entry to nursing homes

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Group Visit Models

• Co-operative Health Care Clinic (CHCC)...Bill
  Scott
• Drop In Group Medical Appointment (DIGMA) ..Ed
  Noffsinger
• Physicals Shared Medical Appointment (SMA)?

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Group Visits A Qualitative Review of Current
Research

• Jaber et al, Journal of the American Board of
  Family Medicine, 2006
• electronic review of all group visit articles
  published 1974 2004 (PubMed, Medline)?

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Group Visits A Qualitative Review of Current
Research

• Patient satisfaction
• Health service utilization
• Quality of care
• Healthy behaviours Self-care
• Disease specific outcomes
• Satisfaction of physicians

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Group Visits Diabetes

• Elizabeth Thompson Beckley, DOC News, July 2004
• Research Favors Group Diabetes Intervention
• Harvard University School of Medicine
• 300 patients, split between group and control
• Fewer hospitalizations, less ER visits

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My Experience with Group Visits

• CDM collaborative
• Diabetes series of three focused on diet and
  food choices
• Diabetes foot care
• Health Point Care Centre
• Diabetes Cooperative Health Care Clinic (CHCC)?

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Notes on our Diabetes Group

• One talkative spouse
• One speech-impaired
• One drop-in resident from Aberdeen Hospital
• Everyone expressed interest in a return visit
• High level of satisfaction
• Very appreciative of timeframe and opportunity to
  learn from others
• Patients seemed to quickly get comfortable with
  the group visit process

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My thoughts so far

• Definitely more work at the outset- planning,
  debriefing, advertising, getting a stable group
• Initially I was aware of being out of my comfort
  zone ...
• I am grateful for efficient MOA's and for a
  skilled nurse
• I have the luxury of a great space to hold group
  visits but others have done amazing things with
  the space they have flexibility is the name of
  the game
• Marginal business case at the beginning patient
  numbers is a critical piece

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My thoughts so far

• The group visits have been memorable and fun
  they stand out in a very positive way I had been
  thinking about doing one for a long time!
• It was refreshing to have a break from regular
  patient flow for a few hours to not feel behind
  and out of control, to have no phone calls, no
  coming and going...
• It was more relaxing for me than my usual busy
  office
• I think it will start to feel easier...

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Changes?

• Develop a better note-taking sheet for collecting
  patient information during the visit
• Watch the time carefully have a time keeper
• Start using a patient-friendly flow sheet
  (Personal Health Book?)?
• Be vigilant with CDM flowsheet info for accurate/
  up to date patient information one-stop shopping
• Get better at pulling the quiet people into the
  conversation
• Ask patients ahead of time who needs to leave
  promptly (so that their needs are met, eg for rx
  renewal)?

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What do patients value??

• They value hands-on care.
• They value trusting relationships with their
  physician.
• They value timewith their physician.

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Leadership Style

• Relationship Focused
• Task Focused

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Golden Group Rules
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Group Rules

• 1. You are a facilitator .. The group should set
  its own educational work load/ topics.
• 2. Do not hog airways. Generally wrap up after a
  minute of explaining.
• 3. It must run on time/ finish on time.

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Group Rules

• 4. You must have support .. MOA involvement is
  key! MOA/RN/secretary to administrate and deal
  with the logistics (charts, room set up,
  phone/letter/ vitals/ refreshments).
• 5. There has to be a strong business case.
• 6. THE GROUP BELONGS TO THE PARTICIPANTS. You are
  a privileged facilitator.
• 7. It must be fun! Humor and positive attitude
  are essential.

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• Just Do It!