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Author List:
Goldstein MK (GRECC, VA Palo Alto)
Fenn C (GRECC, VA Palo Alto)
Olkin I (Stanford University)
Hoffman BB (VA Boston-West Roxbury)
Objectives:
Many patients with hypertension do not meet targets for adequate control. Group medical visits (GMVs) may enhance patients’ self-management of their hypertension as a step toward better control of blood pressures.
Methods:
Both physicians and patients are randomly allocated in 2:1 ratio of GMV: usual care. Patients in GMVs see their own physician in a shared medical appointment during which a nurse provides education and a facilitator encourages group discussion of self-management of diet, exercise, and medication regimen. The study protocol includes implementation in stages with a formative evaluation after 6 months and subsequent enrollment of additional providers and patients. An organizational component tracks steps to implementation so that we can develop materials assisting other sites in setting up a GMV program. We report here formative evaluation data for the first 2 GMV groups after 6 months.
Results:
All 9 patients who evaluated the 6-month GMV were extremely or very satisfied with extent to which their medical care needs were met, individual attention they received from their provider, and their understanding of the recommended follow-up care. The lowest rating for any of 9 patient satisfaction questions was “fairly satisfied.” Physicians leading GMVs were only fairly or somewhat satisfied with GMV as a substitute for a regular clinic visit, but were extremely or very satisfied with the approach to medical care and the time they had to address patient needs. There were not statistically significant differences in blood pressures in this small initial group. Organizationally, we identified and addressed, in collaboration with the medical center’s clinical administration, issues with space, appointment scheduling, timing of check-in, charting, and roles of each of the team participating in the GMV.
Implications:
Among initial participants, both patients and providers participating in group medical visits saw the visits as meeting medical care needs well. Introduction of a new model of care delivery presents organizational challenges. Planned data collection will allow future analysis of impact on patients’ blood pressures, medication adherence, and confidence in self-management of hypertension.
Impacts:
Group medical visits are a new model of health care delivery that hold promise for improving patient access, patient and provider satisfaction, and clinical outcomes.
