1. Group Medical Visits Learning Session

2. Dr. Fines Group Medical Visit Welcome 2

3. Group medical visits are one-to-one medical appointments in a group setting Self management empowers patients to become partners in their care Health literacy is about ensuring patients understand basic health information Introduction 3

4. Practice Reflection Have you ever organized a group medical visit to deliver individual care to multiple patients at once? Have you introduced patient self-management strategies into your practice? Have you considered the Literacy of your patient? Have you made any changes based on your practice self assessment? 4

5. GPSC and PSP GPSC – Who, What, Why Practice Support Program (PSP)  Who, What, Why  Reimbursement  Accreditation – Main Pro C, Main Pro M1 5

6. Group Medical Visits 6

7. http://www.youtube.com/watch?v=Fi9nTCZoRfA Fresh Ideas Video 7

8. Increase patient doctor relationship Improve access Efficient way to meet clinical guidelines Greater attention to psychosocial Support other patients Decrease patient phone calls Improve patient self management Improve patients understanding of their health issues Improve patient satisfaction Improve provider satisfaction Improve cost Group Medical Visit Benefits 8

9. Literature – Dr. Ed Noffsinger 200%-311% ↑ in MD productivity 92% ↑ in pt satisfaction 87% of patients returned to groups for their care Up to 73% ↓ in wait times (Noffsinger E, Various studies) 9

10. The Power of Group Medical Visit A REAL, local example from Masset, BC Significant improvement in completion and target rates MeasuresMassett Clinic’s Goal All BC (data)Masett Clinic Data (1:1 visits) Masett Clinic Data (GMV) A1c < 7.085%45%58%75% B/P < 130/8060%47%53%62.5% Annual LDL < 2.570%34%38%60% Annual ACR < 2.0M < 2.8F 85%32%44%50% Annual foot exam90%36%83%100% Annual documented self management goal 85%34%74%100% 10

11. Why a group medical visit instead of 1:1? Physician Quote: Dr. Becky Temple “Since starting group medical appointments for my depressed and anxious patients I have felt much more satisfied with the care I am providing....allowing me to share CBT exercises, and medication information in a much more detailed manner to several patients at one time; patients find it valuable to discover that they are not alone in their struggles with symptoms and to hear about how others have successfully managed their illness with medications and other therapies....much more powerful than me saying so as a physician" 11

12. Patient Quote: Brian “Group medical visits, I think everyone should attend at least one and let them be the judge. Most of my doctors appointments are group medical appointments”. “Questions that I would have liked to have asked but didn’t have the courage to, someone else asked and I learned from that. Questions that I didn’t even think to ask were asked and I learned even more”. 12

13. Group Visit Models Model 1: Cooperative Health Care Clinic (CHCC) Model 2: Drop-in Group Medical Appointments (DIGMAs) Model 3: Physicals Shared Medical Appointments (SMAs) 13

14. Common Features of All Group Medical Visit Models: -These are 1:1 medical appointments that happen in a group setting (i.e. assessment, diagnosis, prescription renewal, review of labs) -Reduce repetition and duplication -In all cases patients will be asked to sign patient confidentiality forms -All physicians and patients will fill out an evaluation form -Groups medical appointments will begin on time and end on time -Patients have 90 minutes with their physician 14

15. Cooperative Health Care Clinic (CHCC) Model Key Concepts: ­ Pre-book 10-15 high-utilizer patients ­ Book the same people in the same group on a regular basis e.g., monthly/quarterly ­ 90 - 120 minutes in duration ­ Consist of individual 1:1 with doctor done in a group ­ Review of test result ­ Question & answer period ­ Topic for education (30 mins.) based on group decision ­ Limited private consultation with doctor after the group 15

16. Drop In Group Medical Appointment (DIGMA) Key Concepts: ­ 80% pre-booked ­ Can be booked from a patient registry for recall ­ Can be Homogeneous group (single issue) ­ Can be Heterogeneous group (various conditions) ­ 12 – 16 patients see their doctor 1:1 in a group dynamic ­ Education is opportunistic with each patient interaction 16

17. Shared Medical Appointments (SMAs) Key Concepts: ­ Pre-booked (80%) ­ Shared physicals appointment (ideal for prenatal, baby-wellness, women’s and men’s health needs, or cardiovascular follow up appointments) ­ 8-12 (max) patients ­ First half of the session is a private physical exam by doctor, while other group members are sharing & learning with behaviourist ­ Second half is doctor patient interactions in a group 17

18. GMV Roles Physician Behaviourist MOA PSP Coordinator 18

19. Physician Role Physician will begin and end appointments on time Have a face-to-face appointment done in a group setting Patients that need to be seen privately can do so at the end Share patient clinical data Chart during the group meeting  Order lab tests  Prescriptions  Document patient self management plan Participate in short debriefing at the end of GMV 19

20. Behaviourist Role  Arrives 15-20 mins early – takes BP, weight, etc  Welcomes patients by asking each to identify their main concern (writes them on flip chart)  Manages group dynamics  Promotes meaningful group discussion while GP is doing chart note  Addresses confidentiality  Collects evaluations  Begins group on time, and ends on time  Participates in short debriefing at the end of GMV 20

21. MOA or Office Staff Role Prepares for Group Medical Visit:  Organizes the group space  Overbooks by 25% (stats show 81% of pre-registered actually show up)  Telephone or mail or email invitation letter Makes a patient information package including confidentiality and evaluation forms, patient self management action plans, most recent flow sheets, etc. As patients arrive assist with BP, weight, foot exam, etc and document Track data/narrative reports/measures Participates in short debriefing at the end of GMV 21

22. Coordinator Role Encourages role maximizing, and facilitates role expansion and any additional training Finds a suitable behaviourist match (requires doctor/MOA input) Attends GMV’s until independent (as needed) Facilitates team debrief after GMV (as needed) Troubleshoots issues (i.e. where to hold the GMV) Continues to keep in touch for support (the whole practice team) 22

23. Mock Group Medical Visit Test in a team at your table the following: 1.Appoint one person to be the doctor 2.Appoint one person to be the behaviourist 3.Appoint one person to be the MOA 4.The rest can be patients Now run through a test Be prepared to share with the group 23