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Thread: Time to See More Patients

  1. #1
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    Arrow Time to See More Patients

    Time to See More Patients

    Posted 02/16/2009

    Shared medical appointments offer physicians an efficient way to meet the demand for appointments and yet spend more time with their patients. Recent postings on Medscape's Physician Connect (MPC), a physician-only discussion board, examine the issues involved in seeing patients in groups.

    "It's very labor-intensive," comments one MPC contributor, "but if well crafted and with the proper resources and personnel, it could really save on clinical repetition. The doc could be saved for individualization."

    A shared medical appointment, also known as a group visit, is when multiple patients are seen as a group for follow-up or routine care. The American Association for Family Physicians (AAFP) notes that the visits are voluntary for the patients and provide a secure but interactive setting in which patients have improved access to their physicians.

    "The opportunity to interact with patients in the same situation, with a medical professional, is invaluable," comments a rheumatologist, who ran medical appointments for osteoporosis patients a number of years ago, until he lost funding. The patient interaction, he notes, "gave these discouraged patients a sense they could manage their disease, enabled them to be more active, which improved their function and psychological outlook. To this day, I have patients saying that this program changed their lives."

    A family medicine physician comments, "There is good documentation in the literature that social support is a more potent factor than good medical care in the management of chronic illness." In addition to the positive affects patients gain from support groups, growing evidence suggests that shared appointments increase medication compliance, reduce the rate of hospital admissions, and improve depression.

    "I have seen noncompliant psychotic patients confront peers and have the peers confront them in return, and it was very therapeutic," says an MPC psychiatrist. A recent study conducted at the Naval Medical Center of San Diego found that the use of angiotensin-converting enzyme inhibitors and beta-receptor blockers increased 20% and 19%, respectively, among patient with heart failure participating in shared medical appointments for 6 months.

    The Veterans Administration uses shared appointments to provide clinical care to chronically ill patients and to encourage them in the self-management of their condition. The AAFP's shared appointment models target 3 patient groups: chronically ill seniors, patients who share a common diagnosis, and patients who need extra follow-up care. At Dartmouth-Hitchcock Medical Center, shared appointments are used for pregnancy clinics, educational sessions for teens with acne, and support groups for persons undergoing knee replacement. One MPC contributor comments that a group visit is "like a mini health fair that's targeted."

    Typically, a shared medical appointment brings together approximately 10 to 20 patients for sessions lasting between 1 and 3 hours. Under the leadership of a clinical team that includes the patient's physician, a registered nurse, a medical assistant, and a behavioral health specialist, sessions combine clinical evaluation, patient education, and group discussion.

    A family medicine doctor describes how shared medical appointments are organized at a primary care clinic. "We identify a cohort of patients and invite them to participate. We review the charts the day before the visit and determine what needs to be accomplished for each patient." During the first part of the visit, the medical assistant obtains vital signs, and each patient is seen by the physician for a brief time to discuss the planned care objectives. A brief educational presentation is followed by a group discussion, facilitated by the care team. He adds, "An evaluation and management visit is billed for each patient, generally a 991213, although if a person has more than 1 chronic condition or an exacerbation, then a 99214 may be appropriate." Information on coding and planning for group visits can be found on the AAFP (Home Page -- American Academy of Family Physicians) and the VA (U.S. Department of Veterans Affairs) Web sites.

    The downside of shared appointments is that they require substantial preparation and resources including ample space, 3 to 4 team members, and administrative support.

    "I can see the handwriting on the wall," says a family medicine physician. The preparations, documentation requirements, and work will probably come out to take as much (or more) time than if I had seen those 6 patients individually." Another contributor adds, "I can't see how a small practice could make it work."

    The rheumatologist whose group visits were suspended because of lack of funding noted that such programs can have a major effect on the management of chronic illness. "This country could save money by adequately addressing chronic medical health problems. We need to determine a way these programs can function in the current cost-conscious healthcare in environment."

  2. #2
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  3. #3
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    ????? the American consult is typically 20-30 min and they still don't have enough time ;-)

    It's different expectations. The problem comes when the number of doctors do not keep up with the rise of expectation, e.g. in Singapore.

    I personally prefer longer consult time but hospitals in Asia are typically workhouses -- if the patient comes in for acute issues, then the other long term but seemingly unrelated ones will be shoved under the carpet till needed.

  4. #4
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    here in guatemala.. i see lots of pts.. only have 15min per patient

  5. #5
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    i get jus ten mins with each patient..if it gets a lil delayed the next patient jus rushes in !govt job in villages is not an easy job!

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