Group appointments can benefit busy doctors and chronically ill patients, according to UCSF research

By Maureen McInaney

Group appointments are a feasible way to deliver care to chronically ill,
low-income women, a UCSF study has found. In this pilot study, a family
physician and family nurse practitioner team guided six 90-minute appointments
for patient groups as large as 15.

Appointments included a 15-minute check-in during which women received feedback
on health goals they had set during their first session, a teaching period with
time for patient questions, and a brief one-on-one encounter with a health
provider. During teaching periods providers discussed a variety of topics
including, nutrition and exercise, menopause, cancer screenings and general
self care. Optional private exams were offered in the 30 minutes following each

“In modern-day ambulatory care settings, clinicians often feel caught between
the frenzy of running from room to room to address a myriad of patient concerns
and the task of repeating the same health information many times,” said Daphne
Miller, MD, former fellow in the UCSF department of family and community
medicine and the lead author of the study. “Patients, on the other hand,
express concern that rushed clinic visits leave them little opportunity to
build a quality relationship with their provider, voice their needs or receive
health education. The limitations of the one-on-one clinical encounter are most
obvious when providing care to patients with chronic health problems.  For
those patients, this model allows a more efficient delivery of health education
and preventive health services,” she said.

Concerns about breaches in privacy or loss of personal attention were mentioned
by relatively few participants, and participants reported that they developed
more of a partnership with their provider and benefited from social exchanges
with other patients, said co-researcher Pilar Bernal de Pheils, RN, FNP, UCSF
associate professor in the department of family and community medicine. Bernal
de Pheils, who presented the study on October 11th at the VII Pan American
Nursing Research Colloquium in Bogota, Colombia, added that chart reviews
indicated a decrease in urgent care visits during the nine months of the pilot
study, compared to the previous nine months.

Study participants included Latina (20), African American (4), Filipina (2),
and white (2) women age 40-64 who had at least one chronic disease including,
but not limited to, cardiovascular disease, diabetes and osteoarthritis,
researchers explained.

“In general these patients require a range of health care services, which are
often difficult to provide within a standard clinic encounter,” said Miller.
“Group appointments give physicians the opportunity to offer evidence-based
treatments and preventive services, self management education, and ongoing
psychosocial counseling.”

In telephone interviews following the group appointments, 77 percent of the
participants felt they had received personalized attention, even in the group
format, said Bernal de Pheils. “This may be because we spent nearly two hours
with patients, while more traditional clinic visits last on average 15
minutes,” she said.

Nearly 70 percent of the patients cited the benefit of self-care education and
convenient access to medication and refills and exams. More than 60 percent
reported a benefit from peer advice. Only four percent of participants reported
a loss of confidentiality.

Group appointments were offered at the Mission Neighborhood Health Center and
San Francisco General Hospital Medical Center (SFGHMC) Family Health Center.
Women with ongoing drug or alcohol dependence or severe medical or mental
illness, which would prevent attendance and/or participation in the groups,
were not contacted for the study.

Researchers emphasize that outcomes of this small study may not apply to
midlife women in other inner-city settings, and that, without a control group,
it is impossible to assess provider productivity or conclude whether the
decrease in emergency room use during the study was due to the group
appointments. The investigators also underscored the importance of informing
prospective patients about group appointments before they are selected to be
sure they can tolerate a group setting.

Additional researchers on the study include Kevin Grumbach, MD, UCSF associate
professor in the department of family and community medicine; Hali Hammer, MD,
UCSF assistant professor in the department of family and community medicine;
Shotsy Faust, RN, MS, FNP, UCSF associate professor of family health care
nursing; Colleen Foy Sterling, MD, director of the women’s clinic at the
Mission Neighborhood Health Center; and Veronika Zantop, MD, a family practice
resident at the University of Washington. The research was funded by The UCSF
Center for Collaboration in Primary Care.