Group Visits for low income and Latino patients: More fun than work! Lucy M. Candib, M.D. Family Health Center of Worcester and University of Massachusetts Medical School

Why group visits -- for us? Better fit for chronic disease, which is what we will all be doing more of.… Satisfaction: –Strength of recommendation A Economically for provider at least a wash –Strength of recommendation: C

Why group visits -- for patients? Outcomes –better control of diseases –improved utilization –better adherence to guidelines –improved satisfaction Strength of recommendation: A

Better fit for chronic disease We grew up with the educational model-- if the patient only knew this stuff, s/he would change. –Therefore we tell the patient stuff and expect that learning it or “knowing” it will make them change. Does that work? What is our experience?

Better fit: empowerment For best outcome, patient must manage condition, which means patient must change, which means patient must be empowered -- –How do patients change? –What do we know, believe about that? –If we acted on it, how would we care for people with chronic diseases?

Themes Empowerment--patients Collaboration--patients Collaboration--providers Facilitation--patients Facilitation--providers Education--patients Education--providers Empowerment--providers

Empowerment--patients Hold own chart, find labs, see consults Write own note Speak own opinion Get needs met Contribute to group Solve collective problems See and celebrate own progress

Collaboration--patients Help provider understand Help other patients to understand Work on common goals Bring own unique abilities to group Feel a part of a healthy group Teach learners

Collaboration--providers Planning Implementation Evaluation Most egalitarian team in my work life My setting: pharmacist, chronic disease nurse, medical assistant, faculty physician, sometimes students Your setting?

Facilitation--patients Get prescriptions more easily Make specialty appointments Solve medication problems Get paperwork addressed (prior approvals, work and housing letters…) Get questions answered I.e., Group helps get things done

Facilitation--providers Update labs and specialty appointments Implement and reinforce guidelines Bring team together on pts’ behalf Joint problem solving--recognize problems, propose and test solutions, revisit and revise

Education--patients Learning from peers Teaching peers Growth over time Various literacy and language levels Various educational levels potential to evolve into promotoras (lay educators)

Education--providers Medical students Pharmacy students Entire staff of health center Collaborative team Ripple outward effect: other health centers, department, state academy, STFM!

Empowerment--providers Most fun in my month Most growth in my understanding of chronic disease--I really did not understand what having diabetes meant before Most desire to teach and learn Best teamwork in my whole worklife