Jennifer Hyland, RN, MSN, CNP, and James Simon, MD
- Evidence suggests that patients with chronic medical problems such as chronic kidney disease stand to benefit from shared medical appointments (SMAs).
- Less resource utilization and fewer emergency room visits are potential byproducts of SMAs.
- Providers gain efficiency in the clinic with an opportunity to offer education to more patients in the shared appointment setting, thereby improving productivity.
Providing safe, effective, quality care to an aging and growing population with chronic medical problems remains a challenge in the ever-changing world of healthcare. Almost half of Americans have a chronic medical problem and at least 25 percent have multiple chronic conditions.
One significant challenge is to overcome reduced patient access to their providers due to demanding provider schedules and heightened expectations of productivity. The provider is expected to do more for the chronically ill patient with fewer resources available. In an effort to conquer these challenges at Cleveland Clinic, the Department of Nephrology’s Chronic Kidney Disease (CKD) clinic has begun offering shared medical appointments (SMAs) for patients with CKD Stages 3, 4 and 5.
An SMA is a 90-minute group session, with a provider (physician or certified nurse practitioner) leading the visit. Typically, eight to 12 patients are present at the office visit. The office visits have the same components as a traditional medical visit, except that a group of the patients’ peers is present to lend social support as each patient’s unique medical needs are addressed.
The SMA provides several benefits to both the motivated and unmotivated patient. Multiple studies in the past several years reveal an increase in patient satisfaction among several different chronically ill populations, including those with asthma, diabetes, obesity, arthritis, migraines and congestive heart failure. The enhanced patient satisfaction was a result of expanded access to the provider, more interaction time and an increase in the amount of education provided. Additional benefits include increased social support and improved coordination of care.
Patients tended to utilize fewer healthcare resources after attending SMAs. They had fewer refill requests, a decline in number of emergency room visits and less need for same-day add-on appointments. The patients began or increased the number of healthy behaviors they performed, such as changing their diet, increasing their intake of fruits and vegetables, and increasing the frequency of blood glucose monitoring.
Education remains a large part of the SMA, with more time available to provide it. The ability to have a multidisciplinary team that may include an MD, CNP, RN, registered dietitian or social worker is another advantage. These patients have the opportunity to learn how to manage their own chronic illness and the skills needed to do so. Patients have expressed a greater sense of trust in their providers, allowing for a more effective working relationship for disease management.
Providers also benefit from SMAs through greater efficiency in the clinic. They have the ability to dispense more education and more time to otherwise interact with their patients. There are financial benefits to SMAs as well. Providers may see a 200 percent to 300 percent improvement in productivity at the same time as they see a reduction in office costs.
The CKD SMA is available to most patients with CKD Stages 3, 4 and 5. The group is not stage-specific, allowing for greater variability and greater opportunity for education through the stages of CKD. Education topics include blood pressure management, diet, delaying progression of CKD and treatment options for end-stage renal disease. Laboratory results are reviewed in a group session, allowing for patients to identify with others in the same disease category. Patients have the opportunity to interact with each other to help in formulating a better treatment plan for themselves.
As the need persists for an innovative, productive way to approach chronic medical disease, SMAs will continue to gain in popularity. Treating the appropriate patient in a group session should eventually prove to be a more individualized, comprehensive visit than imagined.