Virtual Shared Medical Appointments
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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.
Virtual SMAs are similar to in person SMAs in several ways.
• The participants in a virtual SMA often share a similar set of conditions.
• A typical virtual 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.
• Before the virtual SMA, it is important to decide on workflow and clearly define the roles of the clinician, facilitator and IT support person (if including one).
However, there are a few key differences with virtual SMAs:
• It may be helpful to add a person to the team who is responsible for the technical aspects of running the session.
• It is not possible to do a physical examination at the time of the SMA.
• An offline facility will need to be made available for personal discussions where needed.
What are the benefits of virtual shared medical appointments?
Virtual Shared Medical Appointments offer several benefits:
• People who live in rural and remote areas can participate without having to travel long distances.
• People who may have mobility issues or who have challenges in attending in person appointments can more easily join a virtual SMA, facilitating continuation of care.
• Virtual sessions can be held at any time. Providers can select a time that works for participants, and evening sessions are often popular.
• Ongoing peer support following the SMA can be facilitated via a private Facebook group or similar online solution.
This Health Care Home ‘Virtual Shared Medical Appointments’ webinar discusses recent experiences with virtual SMAs in New Zealand.
This British Society of Lifestyle Medicine video describes a suggested process and set up of virtual SMAs
Many useful resources on Virtual SMAs are available on the British Society of Lifestyle Medicine website
Equity and health literacy in the virtual environment
COVID-19 has had a huge impact on the way people use technology. Zoom sessions and virtual activities have become a much more normal way of doing things. However, not everyone has access to the devices and technology needed for an effective virtual consultation, or they may not be confident using them. Additionally, many people live in areas where the broadband width is insufficient for videoconferencing. Helping participants and whānau work through these issues by discussing choice of venue, talking to whānau who have and know how to use suitable devices, etc will enable improved participation in the SMA.
Communication and relationships are at the heart of any consultation, be it virtual or in person. Many people will feel uncomfortable with sharing personal medical information in a virtual environment with people they have not met in person.
Setting up an in-person group session prior to the virtual SMA, for participants who are able to travel, can allow people to meet and can help build confidence.
These telehealth videos whilst not directly about SMAs have some useful tips about working with people in a virtual environment.
Equity and improving access with telehealth
Health literacy – getting the most out of telehealth
The success of any group session relies on effective group dynamics and the participation of all members of the group. This is equally important when running a virtual SMA. The skills required to facilitate groups 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 to have 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 Virtual SMAs’ developed by Health Literacy NZ & Health Navigator NZ. Develop new link and add new document
Virtual Shared Medical Appointments (SMA), Health Care Home Collaborative, NZ, 2020
Virtual resources for implementing virtual group consultations now, Alison Manson, British Society of lifestyle medicine, UK
Virtual Group Consultations, British Society of lifestyle medicine, UK
Equity & Improving Access with Telehealth Webinar, Mobile Health, NZ, 2020
Health literacy - Getting the most from Telehealth Webinar, Mobile Health, NZ, 2020
Shared Medical Appointments Workshop for Practitioners and Facilitators, The Australasian Society of Lifestyle Medicine