Group Visits
Known in NZ as Shared Medical Appointments (SMAs)

​Overview

SMAs are a series of individual medical consultations in a supportive group setting, where all can listen, interact and learn. SMAs are an evolving way of managing long-term conditions in primary care. An SMA is both an individual consultation and an opportunity for participants to share experiences and knowledge.

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​Key points

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1. Shared medical appointments (SMAs) are a series of individual medical consultations in a supportive group setting so everyone can listen, interact and learn. They are also known as group visits and group consultations.

2. SMAs are an alternative to, not an addition to, routine care.

3. A typical SMA lasts about 60–90 minutes, has 6–12 patients and includes a doctor and a trained facilitator who manages group dynamics and directs the sessions.

4. SMAs have been shown to be an effective way of engaging patients in self-managing their long term conditions.

5. Recently, virtual SMAs have been developed, mainly in response to the impact of COVID-19 on continuity of care. These are proving to be a valuable adjunct to service delivery.

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What are shared medical appointments or group visits?

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SMAs are a series of consecutive individual medical consultations in a supportive group setting, where all can listen, interact and learn. SMAs are an evolving way of managing long-term conditions in primary care. An SMA is both an individual consultation and an informal group education session.

 

What are the benefits of shared medical appointments or group visits?

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• Group exposure in SMAs combats isolation, which in turn helps to remove doubts about one’s ability to manage illness.

• Patients learn about disease self-management vicariously by witnessing others’ illness experiences.

• Patients feel inspired by seeing others who are coping well.

• Group dynamics lead patients and providers to develop more equitable relationships.

• Providers feel increased appreciation and rapport toward colleagues, leading to increased efficiency.

• Providers learn from the patients how better to meet their needs.

• Adequate time allotment of the SMA leads patients to feel supported.

• Patients receive professional expertise from the provider in combination with first-hand information from peers, resulting in more robust health knowledge.

• Patients have the opportunity to see how the physicians interact with fellow patients, which allows them to get to know the physician and better determine their level of trust.

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What are the different types of shared medical appointments or group visits?

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There are two main types of SMAs:

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1. Drop-in group medical appointments (DIGMAs). DIGMAs can involve heterogenous groups with a range of standard medical problems. They are conducted at a standard time each week to reduce waiting time and make acute care more accessible. 

2. Programmed shared medical appointments (PSMAs). PSMAs are a sequence of SMAs in a semi-structured form, providing educational input relating to a specific topic. A good example is a diabetes-focused group, which allows patients with diabetes to come together regularly to listen, interact and learn from each other, and which provides a good opportunity for a facilitator with extra training in diabetes to educate through a lecture or discussion format.

 

What is a typical format for shared medical appointments or group visits?

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SMAs could comprise 6–12 patients at a time and typically include a doctor and a facilitator, who is usually an allied health professional. The facilitator is the one who manages group dynamics and directs the 60–90 minute sessions. 

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Group visits in secondary care settings can be much larger, with 30 or more patients, and in some UK hospitals who have been trialling over the last few years, this format is proving very popular with both patients and staffs.