Define the group medical visit.
Review the most common group medical visit models.
Discuss the advantages of group medical visits, particularly for underserved populations.
Describe some of the obstacles to establishing group-based models of care in safety-net health settings, at the clinic, provider, and participant levels.
Liu Su Chen is a 72-year-old woman with type 2 diabetes, hypertension, and osteoarthritis. Mrs. Chen neither speaks nor reads English. Mrs. Chen’s diabetes is now poorly controlled. Consultations with a nutritionist and diabetes educator have had little effect on her glycemic control. She is now on maximum doses of oral diabetes medicines and medications for other chronic medical problems. When her doctor begins the discussion of adding insulin treatment, Mrs. Chen becomes visibly upset. “I only know one person who has taken insulin for her diabetes, and she died within a year of starting the shots!” she says. A colleague of Mrs. Chen’s physician recently began offering diabetes care to groups of 8 to 15 patients in Cantonese and English and she wonders if those visits might help her patient.
Efforts to reform ambulatory care have focused on optimizing access to care while making efficient use of limited resources. This chapter describes the group medical visit (GMV), an approach that is gaining widespread acceptance and has been studied in diverse health-care settings and patient populations. Both the advantages and challenges of providing group-based care, particularly among underserved populations, are reviewed.
WHAT IS A GROUP MEDICAL VISIT?
Mrs. Chen’s doctor convinces her to attend one of the new group medical visits by pointing out that she may meet other people who are taking insulin, and that everything will be presented in her language.
Many different models of group-based care have been developed, each tailored to the specific population served. Most of the existing models of group-based care were developed in managed care or academic practice settings. The GMV has taken a variety of names, such as the “cluster visit,”1 “chronic care clinic,”2 “shared medical appointment/drop-in group medical appointments,”3 “cooperative health-care clinic,”4,5 and group prenatal and early parenting visits trademarked as “CenteringPregnancy®” and “CenteringParenting®.”6 All of these groups have been implemented as a means of improving the quality of care, the patient care experience, and access to care when compared with the traditional brief, one-on-one clinical encounter (see Box 16-1).
Box 16-1. Components of Group Medical Visit Models
Peer support and community building included in the clinical encounter.
Point-of-care collaboration by an interdisciplinary team.
Interactive group learning.
Focus on self-management and self-efficacy.
A GMV is a clinical encounter typically organized and run by a team that includes a provider (physician or advanced practice clinician) plus another member of the health-care team and is comanaged by the participating patients. Most GMVs target patients ...