A new clinical visit format: shared medical appointments (SMA)

Glòria Galvez

The model of patient-centred care suggests the need to redefine some models of care and look for others that respond at the same time to the needs of patients and professionals. An example of innovative care is that which affects the traditional medical consultation, which is insufficient to address certain diseases with a prominent psychosocial component.

Shared medical appointments (SMAs) have been used successfully for more than a decade at the Cleveland Clinic, Kaiser Permanente and some Australian centres. They were proposed for the first time by Noffsinger in the United States, in the mid-1990s, as a complementary tool, but not as an alternative, to individual visits. Shared medical appointments have the potential to reinforce the interaction between patients and professionals, evidencing greater accessibility, less frequent visits and better results reported by patients, as well as increasing their satisfaction and capacity for self-care. They are performed in sessions of between 60 and 90 minutes in which 8 to 14 patients participate along with several healthcare professionals. Previously, and in accordance with ethical and legal considerations, patients are asked to sign the informed consent to participate in the session. Patients, family members and professionals interact in an environment that facilitates the raising of doubts, in addition to sharing concerns and experiences, which favours the learning of the participants. This innovative form of care entails a change in the dynamics of power, since it’s the patients who set the pace of the session according to their needs and not the priorities of the professionals. In this group setting, everyone (patients, relatives and professionals) listen, interact and learn by exchanging more information than in an individual visit.

At Hospital Vall d'Hebron, some experience has been carried out with patients diagnosed with prostate cancer accompanied by relatives and with professionals from the multidisciplinary team (urologists, radiation oncologists, nurses, social workers). In these sessions the patients had more and better interaction with the professionals, being able to ask and exchange impressions, advice and experiences. At the end of the session it was evident that group visits are effective not only for patients with chronic diseases such as diabetes, but also for patients with urological conditions such as prostate cancer, erectile dysfunction or benign prostatic hyperplasia, despite the sensitive nature of the topics discussed. The experience was evaluated satisfactorily by patients, family members and professionals, so it has been decided to extend this type of session to patients with other pathologies to which it’s applicable.

These visits have several advantages for both patients and professionals. Thus, Egger et al. affirm that patients improve their accessibility, care is provided in a more relaxed environment, they feel that there is mutual support and feedback between them, they receive a fully multidisciplinary care, they get answers to useful questions that they might not have formulated in a traditional visit, they improve education for self-care and get answers to their psychosocial needs.

For professionals, on the other hand, they offer a more efficient management of time, better management of waiting lists, reduce the repetition of information and advice and have the opportunity to get to know patients better in an interactive environment.

But the advantages are also for the health system. The systematic reviews of Edelman and Quiñones list the benefits for patients with chronic diseases: they reduce urgent visits, hospitalizations, improve metabolic control in diseases such as diabetes, reduce visits to specialized care and there is better knowledge about the disease and healthy behaviours

A health based on value, which takes into account the benefits for the patient, for professionals, for the system and for society, requires a change in the focus of care, with innovative models that improve the patients' experience. Shared medical appointments are an example of innovation in health care, which, in addition to many other advantages, have the potential to strengthen the relationship between patients and professionals.