Engaging The Patient

Zeev Neuwirth, M.D., Harvard Vanguard Atrius Health - Chief of Clinical Effectiveness and Innovation

Harvard Vanguard’s Zeev Neuwirth, M.D. & Deb Prescott- The typical 15-minute doctor’s appointment is frustrating and unsatisfying both for the patient, who often leaves with questions unanswered, and for the physician, who feels rushed and pressured to get to the next patient.

Shared Medical Appointments or SMAs is one solution to improving access and physician job do-ability.  A Shared Medical Appointment (SMA) is a 90 minute group patient visit in which 8 to 12 patients experience a medical visit together, with their own primary care provider or specialist.

Deb Prescott, Harvard Vanguard Medical Associates Director of Shared Medical Appointments

The doctor/clinician is supported by a team: a documenter (or scribe who is writing the medical note real-time as the visit occurs), a behaviorist (who facilitates group dialogue and serves as a patient advocate), a nurse and/or medical assistant (who takes vital signs, updates immunizations and health maintenance screenings).

Harvard Vanguard has one of the largest ongoing Shared Medical Appointments in the U.S. with over 75 launched, in 16 different specialties and over 10,000 patient visits since the program began in 2008.

The purpose of a SMA is to: (1) improve timeliness and access to care; (2) increase the quality of care through a medical team that provides systematic support for each visit, (3) increase the amount of face time between patient and health care providers that fosters a trusting, partnering relationship; and (4) provide the patient with the support, empathy and advocacy of other patients.

The SMA increases the efficiency and capacity of medical care. The number of patients that can be seen in 90 minutes typically increases by 200% to 300% if sessions are filled.  For example, a physician who, on average, sees 4 patients in 90 minutes could double that, and in some cases, triple that number of patients while maintaining, and possibly enhancing the quality of care and the relationship between the clinician and each patient.

Consumer engagement and partnerships in primary care and shaping system

The group visit allows patients to serve as advocates and supporters of one another.  Patients ask each other questions, challenge one another’s assumptions, offer empathy and emotional support, advocate for one another, and share each other’s’ experience and wisdom —  all while the medical visit is being conducted.  The model creates a highly empowering dynamic that fosters tremendous engagement on the part of the patients and their family members who attend these group patient visits.

In a way, this model creates a real-time face-to-face social network as medical care is being delivered.  For example, patients counsel each other during the medical visit about what questions to ask the doctor or they reinforce what the doctor is saying.

Another aspect of enhanced patient (consumer) engagement derives from the fact that the physicians are freed up from paperwork and other administrative duties, so they can focus more on listening to their patients — really partnering with each patient to set goals. The physician can also observe their patients helping each other and interacting socially. This reduces the sense of isolation, intimidation and trepidation that patients may experience when seeing their doctor in the individual visit setting.

We have some evidence that our patients feel much more engaged and in partnership with their provider. For example, the patient satisfaction survey scores in SMAs are comparable to individual visits; and with some questions such as, ‘the doctors sensitivity to my needs’ and ‘ability to get a desired appointment’ patients actually score their SMA experience higher than in the individual visit appointments.

We Believe That…

It is our belief that the SMA model works especially well for the elderly, patients with chronic disease or other homogenous groups such as patients dealing with obesity, pre-operative exams or consultations, the under-served populations, as well as in situations in which patients have difficulty gaining access to care and/or could use additional support and advocacy from other patients/caregivers who are dealing with similar issues.  SMAs have also been highly beneficial with patients struggling with chronic pain and addiction; and Harvard Vanguard is beginning to target the pediatric population to address childhood obesity and asthma.

Harvard Vanguard has Discovered

Harvard Vanguard has discovered that once providers and patients actually experience a SMA, the vast majority are enthusiastic about it.  The most significant challenge to developing a fully functional SMA program is operational.  Success requires a highly standardized, team-based approach that entails planning, preparation, training and very rigorous on-going operational attention.  The other major challenge is making sure to invite enough patients to fill the groups. Our growing success with this model is due to a very organized, systematic and replicable protocol that is employed with the support and development of a true medical team.  This model requires that providers and staff learn to work together in a highly collaborative way.

About The Authors

Zeev Neuwirth, MD SM
Chief of Clinical Effectiveness & Innovation
Dr. Zeev Neuwirth was appointed Chief of Clinical Effectiveness & Innovation in December 2008. In this role, Dr. Neuwirth leads the organization’s efforts in developing and implementing innovations in health care delivery such as in our shared medical appointments program, process and quality improvement, and leadership development. Dr. Neuwirth also assists and advises in strategic planning and the patient-centered medical home project.

Deb Prescott

Debra Prescott is the director and program manager of shared medical appointments at Harvard Vanguard Medical Associates, an affiliate of Atrius Health in Newton, Massachusetts. Ms. Prescott plans, directs, and oversees all activities surrounding the development, implementation, and clinical management of the shared medical appointment program at Atrius Health. She has worked for Harvard Vanguard Medical Associates for over 25 years.