Shared Medical Appointments
A series of consecutive individual clinical consultations delivered in a supportive group setting, where all can listen, interact, and learn.
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What are shared medical appointments?
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.
Shared medical appointments are different to, and should not be confused with, group education sessions.
Shared Medical appointment British Society of Lifestyle Medicine. Video describes ‘what is a group consultation’ (SMA)
What are the benefits of shared medical appointments?
Patients receive professional expertise from the provider combined 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.
Patients learn about disease self-management vicariously by witnessing others’ experiences.
Patients feel inspired by seeing others who are coping well.
Patients feel less isolated after being part of an SMA, which can help them feel more confident managing their illness.
Group dynamics lead patients and providers to develop more equitable relationships.
Providers learn from the patients how better to meet their needs.
What are the different types of shared medical appointments or group visits?
There are four main types of SMAs:
1. Programmed shared medical appointments (PSMAs)
PSMAs are a series of individual medical consultations, in a supportive group setting, that also provide educational input on 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 the group using a lecture or discussion format.
In this video, John Stevens describes how a PSMA runs in his practice
An example of a PSMA - Australian Lifestyle Medicine group weight loss for men:
2. Individual or one off SMAs
Patients are invited to one off session that is either topic based or set up as part of a rolling programme for annual or quarterly reviews.
3. Drop-in group medical appointments (DIGMAs)
DIGMAs can involve heterogenous groups with a range of medical problems. They are conducted at a standard time each week to reduce waiting time and make acute care more accessible. People learn from hearing each other’s experiences, can start to see common risk factors, eg. effect of smoking, obesity etc on health, and the value of healthier lifestyle choices such as keeping active and healthier eating for most health conditions. They can also pick up a range of self-care skills they can share with their whānau, eg how to manage skin infections, the treatment and prevention of gout or recognising that a chronic cough isn’t normal.
4. Virtual Shared Medical Appointments
Virtual SMAs are a virtual space where one-to-one consultation take place as part of a group. The format of a virtual SMA and an in person SMA are similar. Read more.
What is a typical format for shared medical appointments or group visits?
An SMA group generally has six to ten patients. While some SMA groups are larger, the group should have no more than 15 patients. Usually, patients share a similar set of conditions. The clinician involved may be someone with the relevant expertise or for example, there may be a partnership between a GP and an invited expert such as a pharmacist or dietitian.
Each patient in the group receives a brief individual consultation with a clinician in the group setting while at the same time benefitting from the group interaction and discussion.
An SMA can last up to 90 minutes.
Ideally, patients should have their tests, screenings and diagnostics completed prior to the SMA. Some groups have found it useful to ask patients to arrive 15–20 minutes earlier and have shown them how to take their own blood pressure, check their weight and do a blood sugar or point of care uric acid test if needed.
The success of any group session relies on effective group dynamics and the participation of all members of the group. The skills required to facilitate this effectively are specific and not necessarily held by clinicians who are involved in running SMAs. A facilitator who is trained in these skills is an important member of the team. A facilitator can have any background – some are doctors, nurses or allied health professionals – but a facilitator does not need a clinical background. A lay leader or peer support worker can be a highly effective facilitator and bring knowledge and attributes with them that improve cultural safety and enhance participants’ experience.
The role of the facilitator must be clearly defined and understood by all members of the SMA leadership team. SMA facilitator training is therefore important. The Australasian Society of Lifestyle Medicine runs both in person and online training programmes. Find out more here.
Read more about SMAs in the Guide to SMAs developed by Health Literacy NZ & Health Navigator NZ.
Australasian Society of Lifestyle Medicine Group Visits page
Pinnacle Incorporated have developed an online step by step guide to running SMAs
Shared medical appointments Australasian Society of Lifestyle Medicine
Kirsh SR, Aron DC, Johnson KD, et al. A realist review of shared medical appointments: how, for whom, and under what circumstances do they work? BMC Health Serv Res. 2017; 7(113)
Egger G, Stevens J, Ganora C, Morgan B. Programmed shared medical appointments: a novel procedure for chronic disease management Aust J Gen Pract. 2018 Jan–Feb;47(1–2)
Wadsworth, K.H., Archibald, T.G., Payne, A.E. et al. Shared medical appointments and patient-centered experience: a mixed-methods systematic review. BMC Fam Pract 20, 97 (2019) doi:10.1186/s12875-019-0972-1
Shared Medical Appointments in Diabetes Care: A Literature Review, American Diabetes Association, Terry Ridge, DNP, ANP-BC, BC-ADM, Diabetes Spectrum 2012 May; 25(2): 72-75
The case for shared medical appointments, The Wiley Clinical Healthcare Hub, Mariam Keji Belgore, Foundation Doctor; Paula Allchorne, Lead Nurse for Urology, Barts Health NHS Trust; James SA Green, Consultant Urologist and Network Director at Barts Health NHS Trust, and Visiting Professor at King’s College, London
Preparation for and Implementation of Shared Medical Appointments to Improve Self-Management, Knowledge, and Care Quality Among Patients With Atrial Fibrillation, Mayo Clinic Proceedings: Innovations, Quality & Outcomes, Volume 2, Issue 3, September 2018, Pages 218-225