As enthusiasm for group medical visits grows, questions arise. Can shared appointments really cut costs and save time, increase access, and meet the needs of physicians and patients?
Imagine accomplishing 15 office visits in 1 1/2 hours, yet providing complete medical care, answering all questions, and watching patients leave arm in arm, talking animatedly about your health-maintenance advice. According to advocates of the group medical appointment, all this is possible with one of the established models of shared visits. While many primary physicians understandably wrestle with the notion of a group visit, which evokes images of support groups, lectures, classes, or even group therapy, others have begun incorporating traditional medical care into this innovative group setting.
Physicians may question whether group visits can cut costs and save time, and patients may fear they are being thrust onto a medical assembly line. While the appointments can cut costs, especially in a capitated setting, and probably do save doctors' time, their main benefit appears to be in improving quality of care and access, using existing resources. Fears that group visits represent impersonal, "mass-produced" medicine can be alleviated with the evidence that patients who attend these appointments report greater satisfaction with their medical care.
The major differences between the 2 shared visits models described in this article (both of which are designed for return appointments for established patients, as opposed to the Physicals SMA model, which is designed for tripling the efficiency of providing complete physical examinations in primary care) are in the structure and goals of the program--and in the continuity of the group composition (see Table 1, page 23). The models have many features in common, however, such as the following:
* Patients are never forced into a group to receive medical care; some prefer the traditional setting.
* All the elements of individual medical appointments are present including one-on-one care.
* There is a focus on updating immunizations and routine health maintenance.
* A broader scope of prevention information can be delivered.
* Greater attention is paid to patients' psychosocial needs, which are known to drive a large percentage of medical visits.
* Preparation is needed before implementing the visits (see "Initial considerations for group visits," page 19).
* The patient's regular physician, along with support staff, is present at each meeting.
* The help and support of other patients is integrated into each patient's health care experience.
* Patients are invited to bring a support person, such as a spouse, family member, friend, or caregiver.
* Individual visits are available after group sessions in both models.
* Individual visits are available between group visits.
Scheduled CHCC group appointments
The cooperative health care clinic (CHCC) model, designed in 1991, is most closely associated with geriatric and disease-specific groups. Registration for the visit is required, and the same patients populate the group from meeting to meeting.
The group appointments are scheduled as frequently as every 2 weeks for the adolescent obstetric group and as infrequently as every 4 to 6 months for disease-specific groups, depending on the needs of the...
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