Shared Medical Appointments: Are They for You?

A few years ago, I needed to make an appointment with one of my doctors. I was told that I could see her sooner if I attended a group appointment, otherwise known as shared medical appointment (SMA). At first, I was very hesitant. A group visit? With my doctor and other patients? How strange. I admit, I was very skeptical and I didn’t go in there with a very open mind. But I went.

The group was all women and was led by the doctor and a nurse practitioner. All of our relevant medical information, such as labs and medications, was listed on the board. We went around the room and discussed our issues and concerns. The doctor answered questions and the nurse practitioner stayed busy with documentation and filling out prescriptions. I did leave the room for my exam with the doctor, of course. All in all, it was a fairly positive experience.

What happens during an SMA?
Just as the name implies, SMAs, or group visits, allow health-care providers (usually doctors or nurse practitioners) to see several people at one time. If you’ve ever had to wait an inordinate amount of time to get an appointment with your provider, you might appreciate getting in sooner…but keep in mind that you’ll be with other people.

Some of you may be envisioning an assembly line of patients, all in hospital gowns, waiting for the doctor to examine them. Rest assured that you keep your clothes on during an SMA. Typically, an SMA consists of about six to fifteen people. Primary-care SMAs are generally of the same gender and age range (for example, middle-age men). Usually, the SMA is led by a team of two or more providers, including a doctor, nurse practitioner, and perhaps a dietitian, social worker, or other specialist. While the doctor conducts a medical exam in a private room, the group might listen to a talk on, say, nutrition, or have a discussion about a particular topic. Time is also spent reviewing people’s lab results and medicines and answering any questions that might arise.

The trend is growing
SMAs are growing in popularity. According to a survey led by the American Academy of Family Physicians, 8.4% of doctors offered SMAs in 2008 (the percentage may be even higher now), up from 5.7% in 2005. Given that there don’t seem to be enough primary-care providers in the US, along with a growing aging population, SMAs make sense. And for people who have multiple chronic conditions, such as diabetes, high blood pressure, and arthritis, for example, the typical 15-minute “in and out” doctor visit isn’t ideal to efficiently and effectively deal with these issues. And of course, with the Affordable Care Act now in place, SMAs are a partial solution to the high cost of health care, and they focus on wellness and disease prevention, as well.

Benefits of SMAs
Besides being more time efficient, SMAs can make a lot of sense. First, doctors and other providers are able to better streamline their time. That means that you can get in to see your provider sooner rather than later. Second, you actually get to spend more time with your provider. Granted, you may be in a room with ten other people, but in addition to having your medical needs addressed, you benefit from hearing from and talking with other folks who may have the same or similar issues to yours. Sharing concerns, tips, and ideas with others can actually help improve your physical and mental health. The support that you receive from the group can be invaluable.

Third, providers don’t have to repeatedly relay the same information over and over to one person at a time. This gives the provider even more time to discuss other things, like how to prevent certain conditions or newer treatments that may be available, that usually can’t be addressed during a regular office visit. SMAs may save money, too. A 2004 study involving people seen in the Kaiser Permanente system showed that those who attended group visits were less likely to go to the emergency room or be admitted to the hospital than conventional care patients.

Do SMAs work for diabetes?
Absolutely! Diabetes care specialists are even harder to come by, especially given that the population of people with diabetes in the US only continues to grow. More and more studies are revealing that people who attend SMAs have better outcomes — including better A1C levels (a measure of glucose control over the previous 2–3 months — than those not attending SMAs. A study published last week in The American Journal of Medicine looked at people with diabetes in a Veterans Administration hospital. Forty people with Type 2 diabetes attended at least two SMAs, 19 attended three or more visits, and 15 attended four visits over a year.

The SMA consisted of 90-minute appointments every 6–12 weeks over a year, led by a doctor, pharmacist, nurse educator, dietitian, and health psychologist. The attendees agreed to share their medical results with the group, and the sessions consisted of education and medical consultation. The group discussed lifestyle changes and provided each other with support and shared experiences, especially around overcoming barriers to self-care. At the end of the study, A1C levels dropped by up to 1% (what would be expected from diabetes medicine). Those who didn’t attend the SMAs had unchanged or even higher A1C levels at the end of the year.

Are SMAs for you?
SMAs aren’t for everyone. SMAs may not be appropriate for addressing very specific medical issues or for people who need medication changes. And not everyone feels comfortable sharing in a group setting. But more and more health-care providers and systems are moving towards SMAs, and so far, it appears that the benefits outweigh any downsides. So, if you have the opportunity, try it out. You might just like it!