Transcript LS 1A Presentation Slides

Group Medical Visits
Learning Session <#>
<to be run alone or in coordination with LS1 content>
Welcome
Dr. Fines Group Medical Visit
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Introduction
• Group medical visits are one-to-one medical
appointments in a group setting
• Self management empowers patients to become
partners in their care
• Health literacy is about ensuring patients
understand basic health information
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Practice Reflection
• Have you ever organized a group medical visit to
deliver individual care to multiple patients at
once?
• Have you introduced patient self-management
strategies into your practice?
• Have you considered the Literacy of your patient?
• Have you made any changes based on your
practice self assessment?
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GPSC and PSP
• GPSC – Who, What, Why
• Practice Support Program (PSP)
 Who, What, Why
 Reimbursement
 Accreditation – Main Pro C, Main Pro M1
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Group Medical Visits
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Fresh Ideas Video
http://www.youtube.com/watch?v=Fi9nTCZoRfA
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Group Medical Visit Benefits
• Increase patient doctor
relationship
• Improve access
• Efficient way to meet
clinical guidelines
• Greater attention to
psychosocial
• Support other patients
• Decrease patient phone
calls
• Improve patient self
management
• Improve patients
understanding of their
health issues
• Improve patient
satisfaction
• Improve provider
satisfaction
• Improve cost
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Literature – Dr. Ed Noffsinger
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200%-311% ↑ in MD productivity
92% ↑ in pt satisfaction
87% of patients returned to groups for their care
Up to 73% ↓ in wait times
(Noffsinger E, Various studies)
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The Power of Group Medical Visit
A REAL, local example from Masset, BC
Significant improvement in completion and target rates
Measures
Massett
Clinic’s Goal
All BC (data)
Masett Clinic
Data (1:1
visits)
Masett Clinic
Data (GMV)
A1c < 7.0
85%
45%
58%
75%
B/P < 130/80
60%
47%
53%
62.5%
Annual LDL < 2.5
70%
34%
38%
60%
Annual ACR
< 2.0M < 2.8F
85%
32%
44%
50%
Annual foot exam
90%
36%
83%
100%
Annual documented
self management goal
85%
34%
74%
100%
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Why a group medical visit instead of 1:1?
Physician Quote:
Dr. Becky Temple
“Since starting group medical appointments for my
depressed and anxious patients I have felt much more
satisfied with the care I am providing....allowing me to
share CBT exercises, and medication information in a
much more detailed manner to several patients at one
time; patients find it valuable to discover that they are not
alone in their struggles with symptoms and to hear about
how others have successfully managed their illness with
medications and other therapies....much more powerful
than me saying so as a physician"
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Patient Quote:
Brian
“Group medical visits, I think everyone should attend at
least one and let them be the judge. Most of my doctors
appointments are group medical appointments”.
“Questions that I would have liked to have asked but
didn’t have the courage to, someone else asked and I
learned from that. Questions that I didn’t even think to ask
were asked and I learned even more”.
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Group Visit Models
Model 1:
Cooperative Health Care Clinic (CHCC)
Model 2:
Drop-in Group Medical Appointments (DIGMAs)
Model 3:
Physicals Shared Medical Appointments (SMAs)
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Common Features of All Group Medical Visit
Models:
- These are 1:1 medical appointments that happen in a
group setting (i.e. assessment, diagnosis, prescription
renewal, review of labs)
- Reduce repetition and duplication
- In all cases patients will be asked to sign patient
confidentiality forms
- All physicians and patients will fill out an evaluation form
- Groups medical appointments will begin on time and end
on time
- Patients have 90 minutes with their physician
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Cooperative Health Care Clinic (CHCC) Model
Key Concepts:
- Pre-book 10-15 high-utilizer patients
- Book the same people in the same group on a
regular basis e.g., monthly/quarterly
- 90 - 120 minutes in duration
- Consist of individual 1:1 with doctor done in a
group
- Review of test result
- Question & answer period
- Topic for education (30 mins.) based on group decision
- Limited private consultation with doctor after the
group
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Drop In Group Medical Appointment (DIGMA)
Key Concepts:
- 80% pre-booked
- Can be booked from a patient registry for recall
- Can be Homogeneous group (single issue)
- Can be Heterogeneous group (various
conditions)
- 12 – 16 patients see their doctor 1:1 in a group
dynamic
- Education is opportunistic with each patient
interaction
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Shared Medical Appointments (SMAs)
Key Concepts:
- Pre-booked (80%)
- Shared physicals appointment (ideal for
prenatal, baby-wellness, women’s and men’s
health needs, or cardiovascular follow up
appointments)
- 8-12 (max) patients
- First half of the session is a private physical
exam by doctor, while other group members are
sharing & learning with behaviourist
- Second half is doctor patient interactions in a
group
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GMV Roles
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Physician
Behaviourist
MOA
PSP Coordinator
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Physician Role
• Physician will begin and end appointments on time
• Have a face-to-face appointment done in a group setting
• Patients that need to be seen privately can do so at the
end
• Share patient clinical data
• Chart during the group meeting
 Order lab tests
 Prescriptions
 Document patient self management plan
• Participate in short debriefing at the end of GMV
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Behaviourist Role
 Arrives 15-20 mins early – takes BP, weight, etc
 Welcomes patients by asking each to identify their
main concern (writes them on flip chart)
 Manages group dynamics
 Promotes meaningful group discussion while GP is
doing chart note
 Addresses confidentiality
 Collects evaluations
 Begins group on time, and ends on time
 Participates in short debriefing at the end of GMV
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MOA or Office Staff Role
• Prepares for Group Medical Visit:
 Organizes the group space
 Overbooks by 25% (stats show 81% of pre-registered
actually show up)
 Telephone or mail or email invitation letter
• Makes a patient information package including
confidentiality and evaluation forms, patient self
management action plans, most recent flow sheets, etc.
• As patients arrive assist with BP, weight, foot exam, etc
and document
• Track data/narrative reports/measures
• Participates in short debriefing at the end of
GMV
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Coordinator Role
• Encourages role maximizing, and facilitates role
expansion and any additional training
• Finds a suitable behaviourist match (requires
doctor/MOA input)
• Attends GMV’s until independent (as needed)
• Facilitates team debrief after GMV (as needed)
• Troubleshoots issues (i.e. where to hold the
GMV)
• Continues to keep in touch for support (the whole
practice team)
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Mock Group Medical Visit
Test in a team at your table the following:
1. Appoint one person to be the doctor
2. Appoint one person to be the behaviourist
3. Appoint one person to be the MOA
4. The rest can be patients
Now run through a test
Be prepared to share with the group
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