Shared Medical Appointments

What is a Shared Medical Appointment?

Shared medical appointments (SMA) have emerged as a new way for healthcare professionals to see clients in medical settings.

Typically, it involves seeing a group of around ten people – wherein each participant is consecutively and individually treated by at least one healthcare professional (e.g. dietitian, registered nurse) (Kirsh et al. 2017).

There is usually a ‘facilitator’ (e.g. a registered nurse) present, who will have undergone specialised training and/or accreditation to guide participants, as well as provide treatment throughout the session(s).

An SMA can be thought of as both an individual consultation and as a group peer support session (Australasian Association of Lifestyle Medicine 2019).

What are the Benefits of Shared Medical Appointments?

A review by Edelman et al. (2015 p. 99) finds that SMAs are an ‘increasingly used system-redesign strategy for improving access to and quality of chronic illness care’.

SMA interventions were also found by this review to effectively ‘improve biophysical outcomes among patients with diabetes’. The study also recognised that SMAs resulted in better blood pressure and HbAIc for participants (Edelman et al. 2015).

Similarly, another systematic review from 2015 by Watts et al. (p. 450) found that ‘primary care Veterans Affairs (VA) SMAs significantly improved AIc results for clients with diabetes’.

A more recent review (Kelly et al. 2017) investigated SMAs for non-diabetic ‘physical chronic illness’ and found that there were nil adverse outcomes in terms of ‘patient harms’. Kelly et al. (2015) states that one of the studies saw a reduced number of hospital admissions for patients who participated in shared medical appointments as opposed to individual appointments.

Why Aren’t Shared Medical Appointments More Popular?

Above findings implores questions such as, ‘why aren’t we offering more SMAs?’, ‘why aren’t there more government-funded SMAs in community health facilities and/or hospitals?’ and, ‘why isn’t there a specific Medicare item number for registered nurses, medical officers and/or other health professionals to run SMAs?’.

The following are potential barriers to the implementation of SMAs as identified by Egger et al. (2014):

Privacy and confidentiality concerns – there would be a need for those involved to sign a confidentiality agreement before each session commences.
People may not want to share their experiences and data with peers.
A facilitator would need to be educated and trained to effectively and efficiently deliver the session(s) in a way that met requirements.
Nurses may specialise in this field and therefore practices would have to pay them accordingly.
Clients need to be educated about SMAs before giving informed consent to take part in the session.
A facility must be adequately organised to host the session, and also to complete documentation, follow-up care/referrals, billing, private examinations and more.
Cost-efficiency must be achieved as well as time-efficiency.
Lack of awareness of SMA existence.
Poor marketing and uptake of SMAs.
Resistance to change.

(Egger et al. 2014)

How do Shared Medical Appointments Achieve Success?

Edelman’s et al. (2015) study was unable to determine the specific reason(s) for the success of SMAs. However, a more recent study by Kirsh et al. (2017) highlights potential reasons for their success:

A reduced feeling of isolation in patients and an improvement in the confidence of individuals in managing their conditions.
Self-management learning as a result of listening to experiences of group members.
Well-coping participants may inspire other group members.
‘Equitable relationships’ between all participants and healthcare professionals.
Enhanced rapport and appreciation between health professionals, which may improve efficiency in care delivery.
Better insights for health professionals regarding fulfilment of their clients’ needs.
More time within the healthcare environment may result in an improved sense of support for clients.
More robust knowledge in terms of health professional ‘expertise’ in addition to peers sharing their lived experiences.
Trust in the health professional(s) may be improved by allowing the clients to observe the interactions between the health worker and other clients/group members.
Improved time-management and scheduling for healthcare workers.

(Kirsh et al. 2017)

Further known advantages of shared medical appointments include: reduced healthcare costs; improved clinical outcomes; first-hand knowledge sharing; improved uptake of health knowledge by patients; new and creative problem-solving by providers; improved health among patients with chronic conditions; more time during the visit; healthcare staff bonding and enhanced collegiality; and an overall improvement in social dynamics (Kirsh et al. 2017; Edelman et al. 2015).

Ideas on How to Help Nurses Deliver Shared Medical Appointments:

Medicare Provider Numbers for registered nurses (with appropriate specialisation qualifications/experience).
Medicare Item Numbers for SMAs.
Increased access to facilitator training, education and accreditation.
Widespread awareness campaigns aimed at potential clients (e.g. people with chronic diseases), carers, health professionals, and organisations/providers.
More high-quality studies (e.g. RCTs) into nurse-led SMAs (e.g. cost-efficiency, reductions in hospitalisations, improvements in vital signs, etc.).
Government funding, scholarships and grants to enable appropriate nurse specialists to run SMA programs and/or set up independent nurse clinics within their scope of practice.
Increased industry/regulatory body/professional network awareness and support of nurse-led SMAs.

(Edelman et al. 2015; Kelly et al. 2017; Kirsh et al. 2017; Watts et al. 2015)

Conclusion

There is sufficient research to suggest that shared medical appointments have a promising role to play in modern health and patient care.

If the SMA model can overcome its primary barriers of funding, stigma and transparency issues, SMAs could be successfully integrated into the healthcare system – thus creating new roles for registered nurses and offering patients previously under-researched health benefits.

References

Australasian Society of Lifestyle Medicine, Shared Medical Appointments, Australasian Society of Lifestyle Medicine Ltd, viewed 9 July 2019, https://www.lifestylemedicine.org.au/shared-medical-appointments.
Edelman, D, Gierisch, JM & McDuffie, JR 2015, ‘Shared Medical Appointments for Patients with Diabetes Mellitus: A Systematic Review’, Journal of General Internal Medicine, vol. 30, p. 99. https://link.springer.com/article/10.1007...
Egger, G, Binns, A, Cole, MA, Ewald, D, Davies, L, Meldrum, H, Stevens, JA & Noffsinger, E 2014, ‘Shared medical appointments, An adjunct for chronic disease management in Australia?’, Royal Australian College of General Practitioners, vol. 43, no.3, March 2014, pp. 151-4. https://www.racgp.org.au/.../shared-medical-appointments/
Kelly, F, Liska, Morash, R, Hu, J Carroll, S L, Shorr, R, Dent, S & Stacey, D 2017, ‘Shared medical appointments for patients with a nondiabetic physical chronic illness: A systematic review’, Chronic Illness, vol. 15, no. 1, pp. 3-26. https://journals.sagepub.com/doi/...
Kirsh, SR, Aron, DC, Johnson, KD, Santurri, LE, Stevenson, LD, Jones, KR, & Jagosh, J 2017, ‘A realist review of shared medical appointments: How, for whom, and under what circumstances do they work?’, BMC Health Services Research, vol. 17, no. 1, p. 113. https://bmchealthservres.biomedcentral.com/articles/...
Watts, SA, Strauss, GJ, Pascuzzi, K, O’Day, ME, Young, K, Aron, DC & Kirsch, SR 2015, ‘Shared medical appointments for patients with diabetes: Glycemic reduction in high‐risk patients’, Journal of the American Association of Nurse Practitioners, vol. 27, no. 8, pp. 450-6.https://journals.lww.com/jaanp/...Shared_medical_appointments_for_patients_with