1. 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

2. 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

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

5. 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?

6. 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?

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

8. 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

9. 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

10. 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?

11. 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

12. 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

13. 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)

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

15. 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