Caring for patients with chronic illness through shared medical appointments

A review published in The Journal of the American Osteopathic Association found that Shared Medical Appointments (SMAs) can reduce costs, improve care and increase patient satisfaction.

SMAs typically include about ten patients with the same chronic condition. The session often begins with an educational presentation and ends with guided discussions about treatment options and best practices for managing the illness. By using a multidisciplinary approach, physicians hope to achieve patient activation by giving them the knowledge and tools they need to self-manage their chronic illness.

Enabling self-care

At the Philadelphia College of Osteopathic Medicine (PCOM), osteopathic medical students and psychology students partner with a faculty preceptor to lead SMAs for diabetic patients.

Patient surveys distributed to PCOM’s SMA patients reveal that this collaborative effort improves patient motivation levels, giving them the spark they need to make important changes to their lifestyle.

Ultimately, the education and facilitated discussions teach patients to take responsibility for their own care while helping PCOM students learn how to measurably improve outcomes for patients with chronic conditions.

“Patients may not connect the fact that you need to be attentive to emotional health,” says Scott Glassman, PsyD, clinical associate professor at PCOM. “This is a perfect multidisciplinary approach to addressing more than one patient’s biopsychosocial needs in a single visit.”

Health care providers who conduct SMAs say they provide a lot more education for a patient than an individual appointment.

Heather Hofflich, DO, an endocrinologist who partners with an orthopedic nurse practitioner to lead SMAs for osteoporosis patients at UC San Diego Health, says the education allows patients to learn from each other.

“Everyone brings in their supplements and talks with the group to be sure they’re taking the right amounts of calcium and Vitamin D,” says Dr. Hofflich. “Someone who might be hesitant to try a medication is more likely to try it when they hear someone else’s experience with it.”

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Caring for the future

The supportive approach of an SMA increases the likelihood of patients adhering to their medication regimens and can reduce trips to the doctor’s office and emergency room down the road. This is crucial when considering up to 27 percent of emergency room visits are considered unnecessary.

More than 40% of Americans suffer from chronic illnesses like diabetes and osteoporosis. Teaching patients to take charge of their own treatment not only drives down health care costs, it improves the physical and mental effects of disease.

At PCOM, physicians in training work with patients individually for half an hour before the group component to identify realistic diabetes-related goals around nutrition, exercise and medication adherence.

“We take them through the process of asking who will support these goals, why it’s important to them, and how confident they are that they can take these steps when they leave the clinic,” says Dr. Glassman. “Our goal is to have patients come out of the session with a self-care plan.”

Patient activation is possible through SMAs, as long as physicians are successful in getting patients to sign up.

“In recruiting someone to come to the visit, people shy away,” says Dr. Hofflich. “But when they do come, they love it and get a lot out of it. I’ve only heard positive feedback.”

PCOM patients agree, reporting that they prefer the SMA to just seeing a physician.

Patient feedback also leads physicians in training at PCOM to value the relationship between osteopathic medicine and psychology.

“There is a cross-pollination of skill sets,” says Dr. Glassman. “DO students look to psychology students to learn how to ask questions in such a way that patients really open up and are willing to trust us with the conflict around diabetes.”