Group Appointments

“If our health care system had evolved differently, had it evolved dealing with chronic diseases - which is the issue today - rather than acute diseases, we probably would have started with Group Visits. And now, someone would probably be preaching about the benefits of an individual office visit as a better model for acute disease management.”

~Edward Noffsinger, PhD, Group Appointments pioneer

Group Appointments - Meeting the needs of Canadians

Group Appointments (GAs), also called Group Medical Visits or Shared Medical Appointments, exist in various forms. Typically, a team of clinicians works together to care for eight to twelve patients during a 60 to 120 minute appointment.

GAs can be weekly, monthly, quarterly, whatever works best, depending on the practitioners, patients, and illnesses involved.

Group Appointments provide benefits to both clinicians and patients that are not possible in a traditional one-to-one consultation. Group Appointments combine three elements:

  1. individualized medical care
  2. disease-specific education, applicable to the group as a whole
  3. life skills development such as short-term goal setting, action planning, and problem-solving to empower individuals for behavioral change.

Typically, a team of clinicians works together to care for eight to twelve patients during a 60 to 120 minute appointment.

Why Group Appointments?

Recent research continues to demonstrate the ability of Group Appointments to positively affect patients’ health.

For example, a systematic review and meta-analysis by Housden, Wong, and Dawes showed that “Group medical visits for patients with diabetes reduced HbA1c…and that the wider implementation of group medical visits for patients with diabetes will have a positive effect on patient outcomes.”

At the same time, group discussions provide patients with layers of understanding and resources, which are limited in one-to-one visits.

For example, instead of a physician educating ten patients separately about diabetes foot care, label reading, or healthy nutrition, the clinician in a group setting conveys the information just once.

The team approach further allows patients to access the expertise of a breadth of professionals, taking pressure off the lead clinicians to know or deliver every aspect of care.

Few clinicians have time in a one-on-one visit to address life skills development. Yet we know that skills such as goal setting and action planning are crucial to the development of effective patient self-management –one of the keys to vital primary health care.

Recent research continues to demonstrate the ability of Group Appointments to positively affect patients’ health.

In contrast, GAs focus specifically on patient self-management. Learning is further reinforced by the dynamics of a group setting in which patients receive the support and are able to gain from the wisdom and experience of others, dealing with similar challenges.

Collectively, these components help patients adopt healthier lifestyles and maintain these positive changes when they experience setbacks or failures.

The Evidence for Group Appointments

Group Appointments have been scientifically studied for over ten years with “great variability amongst the studies in relation to setting; components included in the intervention; and measurement of clinical, cost, and utilization outcomes.” 4

Both Group Appointments and research have been limited to a few chronic illnesses, primarily diabetes, mental health, and healthcare utilization.

Along with improved clinical markers, Group Appointments may “reflect the ideal of patient-centred” care. 5

“Since patients may not have the skills or confidence to express what they need or want in relation to their care, facilitating empowerment in patients through a GMV environment that allows them to transition from being passive to active participants in their care can be a solution to better patient outcomes in PHC.” 6

Initial findings are promising and more research is needed in terms of the impact Group Appointments can have on specific chronic illnesses, other than diabetes, Equally important, is the need to understand the effectiveness of GAs in terms of patient/practitioner satisfaction and within a fee-for-service setting “when the profit motive is essential to the practice model.” 7

You and Group Appointments

Good news for Canadians!

If you are a practitioner, patient, researcher, or policymaker interested in Group Appointments two major resources on Group Appointments exist and relate to various medical settings (i.e., not primary care alone). The ‘Bible’ of Group Appointments is Dr. Noffsinger's 500-page book Running Group Visits in Your Practice (2009). In it, he describes two main types of Group Appointments, neither limited to the primary care setting.

A second foundational source for Canadians in particular, is The Group Medical Appointment Manual (First Edition 2007) published by the Northern Health Authority in British Columbia (developed after a visit by Dr. Noffsinger). 8

 

Check out our Resources Section >

 

To learn more about Group Appointments or the work of the CCGA contact us.

Partners & Associates

© 2013 Canadian Centre for Group Health Appointments  |  All rights reserved.