90 minutes in a room with your clinician

Imagine calling your primary care physician's office for a follow-up visit and being told there is a several-week-wait for an appointment, but you can be seen next week if you schedule a shared appointment.

A shared medical appointment is an innovative model of care seen more and more throughout the United States in leading-edge primary care groups. It involves a 90-minute visit with a multi-disciplinary medical team comprised of your doctor, a behaviorist, a medical assistant, and a documenter. After a brief discussion about confidentiality, the primary care provider interacts with each individual, one by one, as other patients listen and observe. Evening hours are made available to accommodate working families and patients who are unable to schedule daytime appointments.

In 2012, we provided a $359,000 three-year grant that made it possible for the Women's Medicine Collaborative to implement, pilot, track, and evaluate shared medical appointments.

"We're seeing an increased demand for primary health care due to the Affordable Care Act," says Dr. Peg Miller, director of the Women's Medicine Collaborative. "But the supply of clinicians tends to be flat so we're seeing problems with access to care." The American Medical Association reports that just two percent of medical school graduates plan to practice primary care.

The SMA model is particularly suited to patients with chronic illnesses in need of frequent medical visits. While there are SMAs for sick visits, it's the theme-focused ones that are the driving force behind the model. Currently, the Collaborative offers SMAs in lifestyle/behavior modification, pre-diabetes, cancer survivorship, and asthma, with three more in the works: menopause, fibromyalgia, and diabetes in pregnancy.

Patient satisfaction remains consistently high, citing advantages like more quality time with physician, reduced wait times for appointments, and receiving support and motivation from other patients with like problems.

Data shows that the Women's Medicine Collaborative has achieved better health outcomes for its patients, including weight loss, increased physical activity, improved stress management, and better control of asthma. At the same time, the Collaborative has increased their capacity to take on new primary care patients. Primary care visits have increased from 600 a month in 2012 to 850 a month in 2015, and the number of primary care patients has grown from 4000 to 5200 in that same time period. It is, at least in part, attributable to the implementation of SMAs.

WMC is the state's largest multispecialty center dedicated to caring for women at all stages of life. "Whatever we do, we want to maintain an excellent patient experience by providing high-quality care, and we want our physicians to love their jobs," says Dr. Miller. "And we want to do this in a cost-effective way."

The Collaborative has become an established resource on the best practices in shared medical appointments. They have developed a training manual and a video, and are distributing findings of the pilot program to help other Rhode Island practices determine whether they would like to adopt the SMA model.

Access to primary care in Rhode Island is a serious concern, and the increasing stress on primary care practices will necessitate changes in the delivery of health care. SMAs may well be in the vanguard of that movement.

"Patients really love this model – when else do you get to spend 90 minutes in a room with your clinician?" says Dr. Miller.  "And providers love this model – they can look at things like diet, exercise, lifestyle issues, things that drive chronic disease – it's very rewarding." 


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Providence, RI 02903


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